NPPB and Pleural effusion: Chest x ray: Significant enlargement of the heart.Chest CT: Pulmonary infection, enlarged heart, and pleural effusion.ECG: ST-segment elevation acute inferior myocardial infarction.CT coronary angiography: No coronary stenosis. Laboratory: Troponin T was more than 10 000ng/L. CK-MB 112.9ng/L. Natriuretic peptide BNP was up to 21 025ng/L. TTE: Enlarged heart and EF 27%, trace 2mm pericardial effusion.