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one of the highest BNPs I've seen. #Congestive-heart-failure

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I don't remember what this pt's other lab work was, but it was suspected kidney failure. I've yet to see a pediatric patient with this high of a blood pressure. C/c of swelling was to his abd. It was distended.

A patient with long-standing high blood pressure developed worsening blood pressure control despite taking several antihypertensive medications as prescribed. Over several months, the patient experienced fatigue, ongoing back pain, and new anemia found during routine blood tests. Kidney function began to decline, shown by rising creatinine levels and protein in the urine. Even with stronger blood pressure treatment, hypertension remained difficult to control, raising concern about another underlying cause. Further tests revealed high calcium levels, elevated total protein, and a reduced albumin-to-globulin ratio. Serum and urine electrophoresis revealed a monoclonal spike, and bone marrow biopsy confirmed multiple myeloma, with abnormal plasma cells replacing normal marrow. Kidney damage from myeloma, along with the use of high-dose corticosteroids in initial therapy, contributed to worsening blood pressure. This case shows that while hypertension is not directly caused by multiple myeloma, it can become much harder to manage when kidney impairment and myeloma treatment are involved. Careful management is needed to reduce risks to the heart and kidneys.

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patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?