This 63 ylo male patient with Hx of CHF, FC IV--II, DCM, HCVD. He was
admitted due to bilateral leg edema. 3 days before admission, progressive whole lower legs edema and scrotum swelling were noted. He had dyspnea on exertion intermittent
claudication in the following days. Shortness of breath while resting, orthopnea,cough without sputum, and chest tightness sensation was complained. No obvious PND were noticed. He oral lasix 1# TID was used, but still not much improvement.
Therefore, he was brought to ER for evaluation. At ER, CXR showed cardiomegaly
with severe pulmonary edema and BNP was 3420. Heart echo revealed global
hypokinesia with ejection fraction: 44:6 % and severe TR and moderate MR and PR and moderated pericardial effusion with massive pleural effusion. There was no
distant heart sound, jugular vein engorgement or hypotension. Under the tentative diagnosis of AE of CHF with pericardial effusion without tamponande signs, he was admitted for further management.