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A 60-year-old man with a medical history of type 2 diabetes mellitus, hypertension and a heavy smoker (30-pack year) was seen in the outpatient department for dyspnoea on exertion, bilateral lower extremities oedema, jugular venous distension. He was initially treated with furosemide orally for suspected heart failure and scheduled for further workup. His shortness of breath symptoms and leg swelling worsened during the interval period and went to the ED. He was mildly hypotensive on the examination. Laboratory tests were unremarkable except for B-type natriuretic peptide of 107 pg/mL (reference 6–100 pg/mL). His initial ECG and CXR are shown in figure 1.
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Contributors All authors contributed equally to the work with JZ as a supervisor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
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