An irregular cause of heart failure

Mrs FW is a 54-year-old nonsmoker who lives alone and presents for review after three months of increasing dyspnoea. She has a past history of hypertension and type 2 diabetes mellitus, for which her medications are ramipril, metformin, gliclazide and pioglitazone. She works in video surveillance security and is minimally active. She states the dyspnoea has recently interrupted her sleeping. She denies having leg swelling and chest pain. When asked, she recalls having intermittent palpitations over the past few years, which she attributes to stress. She has no history of travel or exposure to infections.

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