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BACKGROUND
Dyspnoea is a common symptom in internal medicine. The origin of dyspnoea is often cardiac or pulmonary. The cause of dyspnoea in this patient with chronic heart failure, 8 months after coronary artery bypass grafting, was a great surprise for the heart failure physician, showing that a more broad view of dyspnoea is warranted in this common symptom.
CASE PRESENTATION
A 70-year-old man was admitted with progressive dyspnoea. The patient had a history of coronary artery disease, with coronary artery bypass grafting 8 months previously and known reduced left ventricular function after myocarditis leading to recurrent cardiac decompensation. Before admission, the patient was treated by an intensifying diuretic regimen and by antibiotics due to suspected worsening of heart failure or bronchopulmonary infection. Physical examination after admission showed a 2/6 systolic mumur over the apex without radiation, and oedema of both lower legs. On auscultation we observed normal breathing without rales but with an inspiratory stridor. Laboratory tests showed elevated C-reactive protein (CRP) as well as an increased white blood cell count. A reduction in the forced exporatory volume in 1 s (FEV1 ) to 1.22 litres...