BMJ  2004;328:758 (27 March), doi:10.1136/bmj.328.7442.758

Clinical review

Interactive case report

A 66 year old woman with breathlessness: case progression

¹ Royal Victoria Hospital, Dundee DD2 1SP, ² Ageing and Health, Division of Medicine and Therapeutics, Ninewells Hospital, University of Dundee, Dundee DD1 9SY

The first 150 words of the full text of this article appear below.

Last week (20 March, p 698) we described the case of Mrs Dempsey, who was investigated for a two month history of breathlessness and swollen ankles. Despite the paucity of cardiovascular risk factors and normal electrocardiographic appearances, we made a presumptive diagnosis of cardiac failure because of her bilateral pleural effusions. She was prescribed an angiotensin converting enzyme inhibitor and her diuretic dose was doubled. Outpatient echocardiography was organised to define the pathology and quantify her cardiac dysfunction.

She was advised her breathlessness was probably a consequence of heart dysfunction. The cause of the potential cardiac failure, though, was not clear. She did not seem concerned by this; she was convinced she did not have heart problems because she had never had chest pain and was excited at the prospect of having "the fluid on her lungs" treated.

We reviewed Mrs Dempsey three weeks later, after her echocardiography results . . . [Full text of this article]

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