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+A 71-year-old African-American woman presented to the hospital with worsening exertional dyspnoea associated with orthopnoea and lower extremity oedema for 3 weeks.
+She had a long-standing history of hypertension and documented G6PD deficiency with prior episodes of haemolysis.
+She was a former cigarette smoker and had family members with G6PD deficiency, hypertension and diabetes mellitus.
+Vital signs measurement revealed a blood pressure of 150/73 mm Hg, pulse rate of 70 bpm, respiratory rate of 24 breaths/min, temperature of 36.6°C and 97% saturation on room air.
+She was comfortable at rest.
+Her physical examination showed distended jugular veins, inspiratory crackles in bilateral lung bases, a laterally displaced apical impulse and bipedal oedema.
+The ECG showed left ventricular hypertrophy and inferolateral T-wave inversions.
+Chest radiography revealed cardiomegaly and mild pulmonary oedema.
+The metabolic panel and troponin levels were normal but the B-type natriuretic peptide was increased at 826.5 pg/mL.
+Echocardiography showed a dilated left ventricle with an ejection fraction (EF) of 30% and mild right ventricular systolic dysfunction.
+Coronary artery catheterisation revealed normal coronary circulation.
+Ethacrynic acid at 50 mg daily was chosen for diuresis.
+She improved after a day but still had dyspnoea, so we added spironolactone.
+Subsequently, metoprolol succinate and losartan were included in the regimen.
+Repeat chest radiography showed resolution of pulmonary oedema.
+The patient's laboratory results during her hospital stay did not show signs of haemolysis nor worsening kidney function.
+She did not develop ototoxicity and was discharged home asymptomatic.