Case history
Case history #1
A 70-year-old woman describes increasing exertional dyspnoea for the last 2 days and now has dyspnoea at rest. She has a history of hypertension for the last 5 years and a 35 pack-year smoking history, but no other established illnesses. Current medications are a diuretic daily for the last 3 years. She has been prescribed an ACE inhibitor but failed to collect the prescription. On examination her BP is 190/90 mmHg, and her heart rate is 104 bpm. There is an audible S4 and the jugular venous pressure is elevated 2 cm above normal. Lung examination reveals fine bibasal crepitations. Echocardiogram demonstrates normal biventricular size, a left ventricular ejection fraction of 60%, and no significant valvular disease.
Case history #2
A 73-year-old woman with a history of myocardial infarction presents to the accident and emergency department. She is breathless and finding it difficult to talk in full sentences. On examination she is centrally cyanosed with cool extremities. Her pulse is 110 bpm and systolic BP only just recordable at 80 mmHg. Jugular venous pressure is elevated 5 cm above normal, there is a gallop rhythm, and the cardiac apex beat is displaced. Respiratory rate is increased and she has widespread crackles and wheezes on chest examination. Echocardiogram shows an ejection fraction of 35%
Other presentations
Patients may present with predominant symptoms of the underlying condition such as chest pain with acute myocardial infarction, syncope with significant valvular stenosis, palpitations with arrhythmias, and viral prodrome with myocarditis.
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