Dyspnoea with normal B-type natriuretic peptide level: don’t miss cardiac tamponade! A case report

A 78-year-old female patient with a medical history of severe aortic stenosis and metastatic ovarian cancer with liver and right iliac bone metastases was admitted for dyspnoea that started during the same day. Six months ago, she was diagnosed with acute heart failure with a B-type natriuretic peptide (BNP) level at 682 pg/mL. Upon presentation, she was hypotensive (85/55 mmHg) and tachycardic (114 b.p.m.). Her BNP level was 278 pg/mL. A bedside echocardiogram showed a large pericardial effusion that was successfully drained. Ten days later, BNP was repeated and was 1147 pg/mL. The pseudonormalization of BNP level was due to the impaired ventricular stretching caused by the chronic cardiac tamponade.