Due to the acute nature of the symptoms and the established clinical link between heart failure, shortness of breath and oedema it was essential to perform a 12 lead ECG. A patient suffering heart failure will typically have an abnormal ECG displaying at least three anomalies (Karaye and Sani, 2008). The study found 98.2% of patients studied had ECG abnormalities. While this research was conducted in a developing country, making direct comparison with the UK difficult, the results are significant enough to not be dismissed. In this case the ECG showed a normal sinus rhythm without other irregularities, indicating another cause of the symptoms (Gillespie, 2006).
As the evidence was suggestive of a non-cardiac cause a urinalysis test was conducted. A urinalysis test can help indicate the presence of significant kidney pathology and provides a quick, easy and cost effective measure (Simmerville et al, 2005). A dipstick test is neither the gold standard or without risk of false positives however it serves as a useful tool in a resource scarce environment. The test revealed 3+ of protein and 2+ of blood. Hanno (2012) identified that urinalysis was both specific and sensitive when measuring protein > 2+ making this result highly suggestive of a renal problem. NICE guidelines (2015) regarding chronic kidney disease highlight the asymptomatic nature of the disease indicating that acute symptoms are not necessarily a suggestion of acute pathology. In addition research by Yuste (2015) has identified a previously dismissed pathogenic role of glomerular haematuria, a combination of significant proteinuria and haematuria, in kidney disease.