Nocturnal dyspnoea in a patient with previous nephrectomy

A fit 69-year-old bus driver presented acutely to hospital following an episode of nocturnal dyspnoea. Co-morbidities included a history of stage I renal cell carcinoma treated by simple left nephrectomy 17 years previously. On admission, ECG demonstrated anterior T-wave inversion (leads V1–V4) and chest X-ray revealed cardiomegaly. Troponin-T was normal. Transthoracic echocardiogram revealed a dilated and functionally impaired right ventricle (RV). Noted …