Published 26 August 2009, doi:10.1136/bmj.b3093
Cite this as: BMJ 2009;339:b3093

Endgames

Case Report

Orthopnoea in a young woman

Jessica Jenkins, foundation year 2 trainee1, Ben Hope-Gill, consultant respiratory physician1

1 Department of Respiratory Medicine, University Hospital Llandough, Cardiff CF64 2XX

Correspondence to: B Hope-Gill Ben.Hope-Gill@CardiffandVale.wales.nhs.uk

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

A 22 year old woman presented with a three week history of productive cough, worsening breathlessness, fever, and malaise. Her medical history included an episode of pneumonia, four years earlier, which had been complicated by type 2 respiratory failure requiring mechanical ventilation. She described pronounced orthopnoea, exertional breathlessness, and ankle swelling since then.

She had normal heart sounds, no murmurs, raised jugular venous pulse, and mild pedal oedema. On respiratory examination she had posterior, bibasal, coarse, inspiratory crackles.

On admission, blood pH was 7.08 (normal range 7.35-7.45), arterial carbon dioxide tension 13.8 kPa (4.7-6.0), arterial oxygen tension 15.4 kPa (11.1-14.4), and standard bicarbonate 20 mmol/l (22-27) on high flow supplemental oxygen therapy; she also had leucocytosis. Chest radiography showed small lung fields and bibasal shadowing.

The patient was intubated and treated for presumed community acquired pneumonia. Further investigations included an echocardiogram showing a dilated and impaired right ventricle with an . . . [Full text of this article]

Causes of diaphragmatic muscle weakness1 2

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