2nd August 2023

A 51-year-old man presents to a medical outpatients appointment with progressive dyspnoea, orthopnoea and leg swelling.

A 51-year-old man presents to a medical outpatients appointment with progressive dyspnoea, orthopnoea and leg swelling. This has been ongoing for 3 months. He has recently immigrated from Argentina, and none of his medical records are available. He tells you no personal or family history of cardiac disease, and he used to have a labour intensive job before migrating. On examination, he has a raised JVP, bi-basal crackles and marked peripheral pitting oedema. An echocardiogram reveals biventricular failure. His blood results are negative for autoimmune disease or vitamin deficiencies.

What is the most likely diagnosis?

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