Progressive shortness of breath

doi:10.1136/bmj.a3095

Published 14 January 2009, doi:10.1136/bmj.a3095
Cite this as: BMJ 2009;338:a3095

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Progressive shortness of breath

K Guha, specialist trainee year 2 , S Piper, specialist trainee year 2, P D Collins, professor of clinical cardiology, National Heart and Lung Institute

¹ Department of Cardiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Trust, London SW3 6NP

Correspondence to: K Guha kguha@doctors.org.uk

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

A 74 year old man reported increasing shortness of breath, whichhad progressed over the previous 18 months. He had three pilloworthopnoea and increasing peripheral oedema. The history indicatedepisodic minute haemoptysis. These symptoms were accompaniedby intermittent fast palpitations. His medical history was unremarkableexcept for childhood rheumatic fever. He denied weight lossand smoking.

Examination showed NYHA II functional status. He was in a hypervolaemicstate with a venous pressure at 4 cm, bibasal crackles, andpitting oedema bilaterally to mid-shin. On cardiovascular examinationhe had a pulse radially of 88 beats per minute irregularly irregular,and a pronounced mid-diastolic murmur associated with an openingsnap heard loudest at the apex.

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1. What is the imaging technique and what views are shown?

2.What is the diagnosis?

3. What is the most likely cause?

1 Transthoracic echocardiogram; parasternal long axis view (left)and four chamber view (right

. . . [Full text of this article]

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