56 year old lady who was first referred to thehospital complaining of low back pain radiating to the left leg.She noted that her left leg had been more swollen than usual belowthe knees for the past 4 months, she felt tired all the time andsaid he muscles felt tender. investigators at this time showed araised serum calcium (2.73mmol/l) and decreased serum albumin(28g/l). the patient was found to have proteinuria. urinalysis andelectrophoresis showed a monoclonal igG band-this is one of thecharacteristics findings of myeloma. additional investigationshowed a proteinuria of 11g/25hrs and decreased creatinineclearance.
-JVP raised
-Oedema of legs and abdominal wall noted.
-pericardial rub present plus other signs suggesting a rightpleural effusion.
Investigation:
-chest x-ray confirmed right sided pleural effusion.
-Echocardiography showed moderate left ventricular hypertrophy withpoor left ventricle function.
Patient became acutely I'll with hypotension (systolic BP 50mmHg).Patient suffered cardiac arrest afterwords, she was resuscitated,transferred to ICU where she had another cardia arrest from whichshe could not be resuscitated.
-What do you think the cause of death was?
-What were the signs and symptoms?
