A 54-Year-Old Woman With Shortness of Breath: Part 2

In part 1 of this 2-part series, we reviewed a case involving a 54-year-old woman who presented with a new report of shortness of breath that was occurring for several days.

The patient is an otherwise healthy woman whose only other medical diagnosis is minimal hypertension, which is well-controlled with the use of an angiotensin-converting-enzyme inhibitor. The shortness of breath presented subacutely and was not accompanied by fever, cough, purulent sputum, hemoptysis, nor significant chest pain.

During detailed questioning, the patient noted intermittent minor pain with deep inspirations. The patient is a certified public accountant, mainly doing desk work, but she maintains an active lifestyle. She is recently menopausal and has not used hormonal medications for at least 10 years. Additionally, she has not smoked cigarettes since attending college. She has had two uncomplicated pregnancies, and her children are now 30 and 27 years old, respectively.

As noted in part one, the data collected from her physical exam (Table 1) and diagnostic testing (Table 2) suggested a high likelihood of pulmonary embolism (PE). Later, a pulmonary CT angiogram study was performed and confirmed PE. A cardiac EKG reveals normal ejection fracture, except for the presence of flattening of the interventricular septum.

Table 1. Physical exam

Table 2. Diagnostic testing

(Answer and discussion on the next page).