Our patient is a 43-year-old woman with a chief complaint of shortness of breath of two days duration.
The pertinent features of her history include the following: Fifteen years ago a heart murmur was discovered during an evaluation for chest pain and palpitations. She was treated with a beta blocker which improved her symptoms. She was reassured that this murmur was not significant.
One week ago, she developed fatigue and generalized weakness and a low grade fever. Two days ago, she suddenly developed dyspnea while running to cross the street. Last night, while getting ready for bed, she noted mild shortness of breath when initially lying down. She was able to go to sleep, but later awakened gasping for breath and had to sit up to breathe. She became freightened, her symptoms persisted and was taken to the hospital by her husband.
There is no history of risk factors for coronary artery disease. There is also no history of rheumatic fever, cough, hemoptysis, leg pain, prolonged inactivity or peripheral edema. She denies intravenous drug abuse.