A 57 year old female was admitted with an acute presentation of increasing breathlessness, pain in interscapular area associated with dizziness and vomiting. There was no orthopnea, paroxysmal nocturnal dyspnea or chest pain.
Past medical history was significant for recurrent SVT between the ages of 15 and 30 which she was able to control by vagal manoeuvres. She was diagnosed to have pulmonary hypertension but no cause was found. She had progressive dyspnoea for last 5 years and was admitted with cardiac failure on 3 occasions.
She was tachycardic with a heart rate of 100 /m and tachypnec with a respiratory rate of 30/m, normotensive -130/90 – no difference in blood pressures in right and left arm, there was no peripheral edema. Examination of precardium revealed RVH with pulmonary hypertension with a diffuse apical impulse, parasternal heave, RVS3, EDM in pulmonary area and parasternal area. There was a dull note in left infra-axillary and infra-scapular areas with absent breath sounds suggestive of a pleural effusion. Her haemoglobin was low at 8 g/l.
Published on: Mar 31, 2015 Pages: 13-15
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