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7th March 2024
A 36-year-old man of Bangladeshi origin comes to the clinic with symptoms of breathlessness.
A 36-year-old man of Bangladeshi origin comes to the clinic with symptoms of breathlessness. He has no past medical history and takes no medications. He drinks 2-4 pints of beer every night. He has a series of investigations which are summarised as follows:
| Hb | 13 | Creatinine | 69 |
| WBC | 7.0 | eGFR | >90 |
| Neutrophils | 4.0 | TSH | 3.0 |
| Platelets | 227 | B12/Folate | Normal |
| Clotting Screen | Normal | ECG | Normal Sinus Rhythm |
| Na | 140 | Chest X-Ray | Splaying of the carina, double density sign in cardiac shadow. Normal lung fields |
| K | 4.8 | ||
| Ur | 6.0 | ||
Clinical examination reveals a mid-late diastolic rumbling murmur with presystolic accentuation and an opening snap and a loud S1. His lungs are clear. What is the most likely cause of his breathlessness?
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