A 75-year-old patient was admitted to hospital for progressing dyspnea and intolerance of physical exercise (NYHA III), without chest pain. History of the patient includes arterial hypertension and significant mitral regurgitation, which was recommended for cardiac surgery. According to the hospital information system, mitral regurgitation is of grade III.

The patient suffered from significant dyspnea during the past week, and general practitioner prescribed loop diuretic due to oedema of lower limbs. Oedema withdrew, but dyspnea did not. The patient was admitted to the hospital.

Admission lab tests did not reveal elevated inflammatory markers. The only pathology found was the level of BNP – 1137 pg/ml (normal value is below 738 pg/ml). During admission, oedema of lower limbs was not present. The patient was eupnoeic, SpO2 94% without oxygen therapy, and auscultation reveals clear vesicular breath sounds on both sides. ECG shows atrial fibrillation.


Chest X-ray during admission:


Echocardiography was performed:

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