title: [Clinical reasoning and decision-making in practice. A patient with shortness of breath and hyponatraemia].
abstract: A 61-year-old man with no significant medical history was referred by the general practitioner with progressive dyspnoea despite treatment with steroids and antibiotics. The patient had severe hyponatraemia. Eventually hypervolemic hyponatraemia due to ischemic cardiac failure was diagnosed. After recompensation by fluid restriction and lisdiuretics coronary bypass surgery was carried out. The patient was discharged free of symptoms. This case is a reminder that heart failure may not present itself in a classical manner but as hypervolemic hyponatraemia.
authors.affiliation: Universitair Medisch Centrum Groningen, afd. Interne Geneeskunde, Postbus 30.001, 9700 RB Groningen.
authors.forename: L J
authors.initials: LJ
authors.lastname: Top
authors.forename: R O B
authors.initials: RO
authors.lastname: Gans
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D002983:Clinical Competence; D001026:Coronary Artery Bypass; D003657:Decision Making; D004417:Dyspnea / Q000209:etiology*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome