A 62-year-old man with hypertension, hyperlipidemia, type 2 diabetes, and chronic kidney disease presents with symptoms consistent with acute decompensated heart failure. He has had multiple hospital admissions over the past year.

During a previous hospitalization, he underwent nuclear cardiac stress testing which was negative for ischemia or infarction. Cardiac catheterization performed at that time showed normal coronary arteries. A 2-dimensional echocardiogram revealed a normal ejection fraction of 60% to 65% with left ventricular hypertrophy, biatrial enlargement, and grade III diastolic dysfunction. Electrocardiogram done at the current visit shows low voltage in all leads.

He is sent for a cardiac MRI which comes back suggesting an infiltrative disease.


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