What's The Take Home?

A 54-Year-Old Woman With Shortness of Breath: Part 2

Ronald N. Rubin, MD1,2 Series Editor

  • In part 1 of this 2-part series, we reviewed a case involving a 54-year-old woman who presented with a new report of shortness of breath that was occurring for several days.

    The patient is an otherwise healthy woman whose only other medical diagnosis is minimal hypertension, which is well-controlled with the use of an angiotensin-converting-enzyme inhibitor. The shortness of breath presented subacutely and was not accompanied by fever, cough, purulent sputum, hemoptysis, nor significant chest pain.

    During detailed questioning, the patient noted intermittent minor pain with deep inspirations. The patient is a certified public accountant, mainly doing desk work, but she maintains an active lifestyle. She is recently menopausal and has not used hormonal medications for at least 10 years. Additionally, she has not smoked cigarettes since attending college. She has had two uncomplicated pregnancies, and her children are now 30 and 27 years old, respectively.

    As noted in part one, the data collected from her physical exam (Table 1) and diagnostic testing (Table 2) suggested a high likelihood of pulmonary embolism (PE). Later, a pulmonary CT angiogram study was performed and confirmed PE. A cardiac EKG reveals normal ejection fracture, except for the presence of flattening of the interventricular septum.

    Table 1. Physical exam







    O2 saturation room




    Table 2. Diagnostic testing

    Tachycardia with no significant cardiac murmurs or gallops

    Lungs: Clear

    Lower extremities: Symmetrical with no calf pain or edema

    EKG shows sinus tachycardia

    Routine CBC and metabolics are within normal limits

    Cardiac troponins: 0.8 ng/L (nL < 0-0.4 ng/L)

    D-dimer assay level: 1100 ng/mL (nL < 500 ng/mL)

    COVID-19 test: Negative

    EKG shows flattening of the interventricular septum


    (Answer and discussion on the next page).