25743872 Visualization

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