7th March 2024

A patient comes to your clinic complaining of shortness of breath on exercise, gradually worsening over time.

A patient comes to your clinic complaining of shortness of breath on exercise, gradually worsening over time. They complain of no chest pain but do get palpitations from time to time. On examination, they have an irregularly irregular pulse but no other signs of note, other than surgical scars over both wrists. 

Bloods performed show an elevated NT pro-BNP of 3000 pg/ml and serum electrophoresis shows the present of monoclonal bands. A 12-lead ECG performed demonstrates small voltage complexes but is otherwise normal. What is the likely cause of their shortness of breath?

Select the SINGLE most appropriate option from the list below. Select ONE option only.