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 BOF 146

 

   

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BOF: 146

A 56 year old female is admitted with a history of progressive breathlessness. On admission she complained of breathlessness on mild exertion and was unable to carry on with her activities of daily living. she had to stop several times whilst climbing a single flight of stairs , was unable to sleep flat in bed , using 4 pillows to prop herself up . She also complained of swelling of her ankles which increased towards evening, there was no history of chest pain or palpitations.

3 years prior to presentation she had been treated for breast cancer and had undergone surgery, radiotherapy and chemotherapy.

On examination she was breathless at rest , there was pitting peripheral oedema , her pulse rate was 110 beats per minute, no paradox,  BP 110/70 JVP elevated to her ear lobe , no inspiratory increase in the JVP ,  apex beat displace to he 6th left intercostal space , there was  a 3rd heart sound best heard at the apex  and a soft systolic murmur at the apex that radiated to her axilla .  Both lung bases were dull to percussion and there were bilateral basal crepitations audible.

In this patient the most likely cause of her condition is:

a)    Malignant pericardial effusion

b)    Radiotherapy induced myocardial fibrosis

c)     Anthracycline induced cardiomyopathy

d)    Non metastatic  manifestation of cancer

e)    Multiple pulmonary emboli

 

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