Time

Events

BNP (ng/L)

 Investigation

1972

Rashkind Balloon Atrial septostomy

1974

Mustard operation

2014

First admission with decompensated acute heart failure.

2017

Admission for decompensated heart failure.

Self-discharged.

Future heart transplantation discussed.

168

2019

Admission for decompensated heart failure

Continues to smoke

Offered heart transplantation assessment

134

June 2020

Admitted with:

·        decompensated biventricular heart failure

·         renal and liver dysfunction

·        LV thrombus

Deemed unsuitable for heart transplantation

Self-discharged

1457

July 2020

Readmitted with:

·        decompensated heart failure

·        acute liver injury

·        LV thrombus resolved.

Guarded prognosis - referred to Palliative Community care.

Self-discharged again

August

2020

Admitted locally with:

•           peritonitis

•           CT suggestive of bowel perforation.

•           Emergency laparotomy showed no perforation but likely pancreatitis.

•           Decompensated heart failure

•           Renal and Liver dysfunction

Patient Deceased – most likely sudden cardiac death

LVEF 15%. Severely dilated RV, severe TR