Clinical Presentation A 72-year-old woman was presented to the emergency department via ambulance with 5 days of shortness of breath, paroxysmal nocturnal dyspnea, and abdominal bloating. The patient had received a deceased donor kidney transplant 9 years ago, for end-stage renal disease secondary to diabetic nephropathy.
Examination Blood pressure: 152/70 mmHg Heart rate: 65 beats/min Oxygen saturation: 94% with 4 L of oxygen by nasal prongs Elevated jugular venous pulse Bilateral peripheral edema on mid-shins Chest radiograph showed bilateral pleural effusions and pulmonary edema Brain natriuretic peptide concentration: 12,713 ng/L (reference range: ≤300 ng/L) Troponin T concentration: 31 ng/L (reference range: 1-14 ng/L) An electrocardiogram and echocardiogram revealed left ventricular hypertrophy but no new abnormalities Medical History Significant for hypertension, smoking, chronic…
