Case #17
Clinical History:
A 31 year old, previously healthy woman presented with three episodes of
acute onset of shortness of breath.
-
One day prior to evaluation she became acutely short of breath for approximately
15 minutes associated with tightness in her chest and a non-productive
cough. Her chest tightness was worse with inspiration. Throughout
the remainder of that day she had dyspnea on exertion.
-
On the morning of evaluation she had shortness of breath associated with
a near syncopal episode including lightheadedness, tunneling of vision,
decreased hearing, palpitations, diaphoresis, and a sense of panic.
This episode also lasted about 15 minutes and was also associated with
chest tightness worse on inspiration. After the episode subsided,
she was more persistently short of breath.
-
At her primary physician's office she had a third episode associated with
heart rate of 140.
The patient has no recent fevers or chills, but did have an episode of
night sweats prior to evaluation. She had no recent upper respiratory
infection symptoms, no history of cough, and no hemoptysis. She has no
history of asthma, but she had experienced episodes of chest tightness
or shortness of breath on first exposure to cold air and some shortness
of breath with exertion. There was no history of cardiac disease
or hypertension. There was no personal or family history significant for
a clotting disorder. She has no recent change in activity, no recent
surgery, no leg swelling, erythema, or cramping. She had completed
a course of Macrobid one week prior to admission. She was a non-smoker.
She had been started on an oral contraceptive pill, Ortho Tri-Cyclen,
4 months prior to admission. Ten years prior she had been on oral
contraceptive pills for one year without problem.
On evaluation her temperature was 99.5 F, respiratory rate was 24, blood
pressure was 120/90, and pulse was 110-120. Lungs were clear. Cardiac
exam showed a normal S1/S2, grade 1-2/6 systolic ejection murmur at the
right upper sternal border, no S3/S4.
Electrocardiogram showed tachycardia with normal axis and intervals.
There was an S1 and Q3. Chest X-ray was negative. The D-dimer
was less than 500.
Click here to go to Joint
Program in Nuclear Medicine home page and Copyright notice.
J. Anthony Parker, MD PhD, Tony_Parker@bidmc.harvard.edu