A 52 y old Iraqi man was admitted to the hospital for dyspnea and lower extemety edema. He is Diabetic on insulin and oral hypoglycemics, hypertensive treated with a combination of ARB and Thiazide diuretic, dyslipidemic on Rosuvastatin.
He had chronic renal failure with renal transplantation 4 years ago in India.
He started to have chest pain, dsypnea, lower extremety edema and increase in weight since 3 months. A work up done in Iraq showed a creatinine level at 3,3 mg/dl, ECG: Sinus rythm with LVH, Cardiac echo EF 50-55%, Modertae concentric LVH, Elevated right-sided pressures at 45 mm Hg of PASP. A cardiac cath done in Baghdad revealed non significant CAD
On admission, he was dyspneic with regular tachycardia. The lungs were clear with lower extremety edema and hepatomagaly. ECG: Sinus tachycardia with LVH. Chest x ray: cardiomegaly with clear lungs. The creatinine level was 4,6 mg/dl. An echocardiogram revealed concentric LVH, the speckle tracking bull's eye imageis shown below.
What is your diagnosis ?
The answer and discussion will be will be posted next week.