A 54-Year-Old Woman With Shortness of Breath: Part 1

AFFILIATIONS:
¹Lewis Katz School of Medicine at Temple University, Philadelphia, PA
²Department of Medicine, Temple University Hospital, Philadelphia, PA

CITATION:
Rubin RN. A 54 year-old woman with shortness of breath: part 1. Consultant. 2023;63(5):e11. doi:10.25270/con.2023.04.000004

DISCLOSURES:
The author reports no relevant financial relationships.

CORRESPONDENCE:
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

Introduction. A 54-year-old woman presents with a new report of shortness of breath for the last several days.

Patient history. 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.

Her physical examination is as follows: blood pressure 110/70 mmHg; respirations 18 breaths/min; pulse 100 beats/min; O₂ saturation on room air 93%; temperature 37˚ C. Chest examination reveals regular tachycardia with no significant cardiac murmurs or gallops. Her lungs are clear to percussion and auscultation, and her lower extremities are symmetrical without calf pain or edema.

Diagnostic testing. The patient’s chest x-ray is unremarkable, with an electrocardiogram (EKG) showing sinus tachycardia with no injury currents. Routine complete blood count and metabolics are within normal limits. Cardiac troponins are 0.7 ugm/L (nL < 0.04 ug/L). Her D-dimer assay level is 1100 ng/mL (normal range is generally < 500 ng/mL), and she tested negative for COVID-19.

(Discussion on the next page).