Congestive cardiac failure in a 65-year-old man

Abstract

A 65-year-old man complained of progressive dyspnoea on exertion for a period of 14 weeks with recent history of orthopnoea. He also gave a history of significant loss of weight (6.5 kg in seven months). On physical examination his heart rate was 120 beats/min and blood pressure was 110/80 mmHg. Jugular venous pressure was raised and pedal oedema was present. Cardiac impulse was just outside the midclavicular line in the 6th intercostal space. Cardiac auscultation revealed first and second heart sounds of normal intensity. Audible S3 gallop was present. Auscultation of the lungs revealed fine bibasilar crepts. Electrocardiogram showed normal sinus rhythm and T wave inversion in leads Vi to V6.