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A man in his 60s presented to our clinic for worsening exercise capacity, dyspnoea on exertion for 18 months and chest pain not associated with exercise. He had medical history of rheumatoid arthritis (RA), Sjogren’s syndrome, Raynaud’s phenomenon, gastro-oesophageal reflux, dyslipidaemia and Parkinson’s disease. He was on hydroxychloroquine (HCQ) for RA at the time of presentation. A nuclear stress test was normal. Cardiac angiogram showed left ventricular ejection fraction of 55%, normal coronary arteries, normal systolic pulmonary pressure but elevated left ventricular end-diastolic pressure, right atrial pressure, pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, which were compliant with diastolic dysfunction and possibly infiltrative cardiomyopathy.
Two-dimensional (2D) echocardiogram showed left ventricular relaxation abnormality and pulmonary hypertension. Cardiac MRI (CMR) showed thin myocardial wall with basement …
Contributors TJV conceived with an idea about this work and approved the final manuscript. MUD and NNS were responsible for drafting the outline and main manuscript, as well as editing of the main manuscript. SI, PNS, PS and SM were responsible for critically reviewing the manuscript for intellectual content and editing of the main manuscript.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Provenance and peer review Not commissioned; externally peer reviewed.