Our patient is a 34-year-old woman with a chief complaint of progressive shortness of breath of 18 months duration.
The pertinent features of her history include the following.
About eighteen months ago she experienced fatigue and dyspnea while jogging uphill during her vacation. Since then, her symptoms have worsened to the point that at the present time, she becomes tired and short of breath with normal activity such as walking up a flight of stairs.
In addition, she reports an episode of syncope 3 months ago while running after her children and experiences occasional chest pain with activity that is relieved with rest. She has also noted ankle swelling for the past two months.
She had two normal pregnancies at ages 22 and 25 without cardiac symptoms and she had no murmurs on examination after the delivery of her second child. She has never used birth control pills or diet pills for weight control, and has no risk factors for HIV infection.
She has no history of orthopnea, paroxysmal nocturnal dyspnea, wheezing or chronic cough. She denies any history of rheumatic fever or symptoms of Raynaud’s phenomenon. There are no known risk factors for coronary artery disease including smoking, and no family history of heart disease.