What lies beneath: poking a hole in the diagnosis

Correspondence to Dr Natalya Kozlova, Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, 100 Woods Road, Macy Pavilion, Valhalla, NY 10595, USA; natalya.kozlova@wmchealth.org Natalya Kozlova (NK), respiratory specialist trainee A man aged 77 years was referred to the emergency department (ED) of our hospital by his primary physician for evaluation of dyspnoea and hypoxaemia. The patient’s medical history was significant for hypertension and coronary artery disease with myocardial infarction and coronary stenting 4 years prior to admission. Routine laboratory evaluation was remarkable for a brain natriuretic peptide level of 557 pg/mL (normal