INVESTIGATIONS AND TREATMENT
Routine laboratory tests showed an increase in B-type natriuretic peptide (2208 pg/mL), total bilirubin (1.98 mg/dL), aspartate aminotransferase (81 U/L), alanine aminotransferase (75 U/L), blood urea nitrogen (33.1 mg/dL) and creatinine (1.46 mg/dL). Chest radiography revealed cardiomegaly with pulmonary congestion. Electrocardiography demonstrated sinus tachycardia (HR: 104 /min). Transthoracic echocardiography showed diffuse severe hypokinesis of LVEF 30.8%, an increased left ventricular end-diastolic diameter of 64.4 mm, and moderate mitral regurgitation (Figure 1).