This is a case of an older adult with a history of cardiac transplantation, who has symptoms and signs of acute heart failure. The treating physicians thought of an infectious pulmonary pathology as a trigger.

It must be taken into account that the cardiac resynchronisation device was implanted one year after the transplant was performed. The disconnection of the cardiac resynchronising system, known as Twiddler syndrome, leads to inadequate functioning of the myocardium, with symptoms such as this given the disordered functioning and contraction.