Author: Martha Dimech / Editor: Sarah Edwards / Codes: CC4, CC8, CP2, PhC1, SLO3 / Published: 02/03/2022
A stocky 38-year-old gentleman with no significant past medical history attends ED with shortness of breath. He claims gradually progressive breathlessness, pleurisy and a dry cough for the past 4 days, despite having just finished a course of antibiotics prescribed by his GP. He admits to occasional smoking of marijuana and use of steroids.
As you are examining him, he points out the indentation over his ankles made by his tight socks and says he feels like his abdominal fat is retaining fluid.
Observations are as follows: SpO2 96% on RA, HR of 102bpm, BP: 156/100mmHg, RR 21, T 36.7degrees Celsius.
An ECG shows generalised bifid p waves, T wave inversion in V5 and V6 and a CXR shows cardiomegaly and venous diversion. Blood tests shows a mild AKI, a troponin level of 48 and a Ddimer of >3000.
7 responses
Interesting case. Especially liked the explanation of the US image
Very interesting case, fantastic approach.
Interesting case
An important differential of a very common ED presentation, thank you
SOB, abdo distension and ankle oedema in younger pt think cardiomyopathy
nice case
Great Revision