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Clinical Review Interactive case report

A 66 year old woman with breathlessness: case progression

BMJ 2004; 328 doi: (Published 25 March 2004) Cite this as: BMJ 2004;328:758
  1. Douglas Lowdon, specialist registrar in medicine for the elderly (,
  2. Marion McMurdo, professor of ageing and health2
  1. 1Royal Victoria Hospital, Dundee DD2 1SP
  2. 2Ageing and Health, Division of Medicine and Therapeutics, Ninewells Hospital, University of Dundee, Dundee DD1 9SY
  1. Correspondence to: douglas

    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 …

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