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Fillers A memorable patient

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BMJ 2003; 326 doi: (Published 15 March 2003) Cite this as: BMJ 2003;326:583
  1. Stefan Schäfer, specialist in cardiology
  1. Aventis Pharma Deutschland, Frankfurt, Germany

    I was in my first year of residency at the university department of cardiology when a 58 year old woman was admitted to the ward because of slowly progressing exertional dyspnoea and fatigue. As requested by the referring physician, I made a thorough cardiological examination. Except for mildly increased serum cholesterol concentrations, she had no cardiovascular risk factors. However, she confirmed that over the past few months she had had increasing difficulty climbing the stairs to her second floor apartment. I noticed no irregularities during her physical examination, but her electrocardiogram showed first degree atrioventricular block and borderline left ventricular hypertrophy. Echocardiography showed moderate left ventricular enlargement and diffusely reduced systolic function. After ruling out relevant coronary macroangiopathy, the diagnosis …

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