Ms. Joanne Dixon is a 27-year-old woman who came to the emergency room for shortness of breath.
She first had the feeling of shortness of breath accompanied by coughing and fever 3 months ago. She went to an immediate care center and was diagnosed with pneumonia and given antibiotics, with some improvement. The following month her shortness of breath worsened and became worse when she laid down to sleep, and she saw her primary care doctor, who prescribed a betamethasone inhaler and albuterol inhaler, with little change in her symptoms. She went back to her doctor a month ago and was given a 2-week prescription of prednisone, 60 mg daily, which made her feel less short of breath at night but did not change her shortness of breath with activity. She came to the ER tonight because she called her doctor to tell her that her legs and abdomen have been swelling up for the last few days, and the doctor told her to go straight to the ER.
+ Raynaud’s phenomenon for 3 years and she was treated for anemia with her last pregnancy. She has been pregnant 3 times and miscarried once at 3.5 months gestation. Her sister and brother have both had “blood clots in the legs.”
Her mother has type 1 diabetes and heart disease (had a heart attack and cath) and her father died of colon cancer at age 60.
Lives with husband and 2 children in Louisville, nonsmoker and nondrinker, never used illicit drugs
The hospitalist repeats the history and physical exam and reviews the test findings so far. Due to the abnormalities on initial workup, the hospital physician consults cardiology to perform a right heart catheterization and orders additional diagnostic tests. He also orders continuous oxygen supplementation and prophylactic dose low-molecular-weight heparin daily, and starts a calcium-channel blocking medication and thiazide diuretic. Over the next hospital day, her blood pressure improves, running 140’s/90’s.