{"ops":[{"insert":"A 44-year-old man presents with worsening exertional dyspnea and fatigability for 6 months, which has now progressed to dyspnea at rest. He also complains of orthopnea and paroxysmal nocturnal dyspnea but is otherwise asymptomatic.\u00a0","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":"His medical history is unremarkable. There is no family history of cardiac disease. He is a very heavy drinker, having consumed around 10 drinks per day for the last 20 years.\u00a0","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":"A full blood count is significant for a platelet count of 140,000\/mm3 (normal: 150,000-400,00) and a MCV of 101 fL (normal: 75-95). A liver profile is significant for an AST of 55 IU\/L (8-48), ALT of 65 IU\/L (7-55), and INR of 1.3 (normal: 0.9-1.1).","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-226_en.png"}},{"insert":"\n"}]}
2
Investigate
ECG + Echocardiogram
{"ops":[{"insert":"The ECG shows an irregularly irregular rhythm. No P waves are visible.","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n\n"},{"insert":"The echocardiogram shows dilation of all four cardiac chambers. The wall thickness of all four chambers is within normal parameters. Cardiac contractility is globally reduced, with a left ventricular ejection fraction (LVEF) of 29%. There is moderate mitral and tricuspid regurgitation. Contrast echocardiography shows no mural thrombi.","attributes":{"color":"#000000","background":"transparent"}},{"insert":"\n"}]}
