Why is this older woman becoming dizzy and breathless?
Case of the month: Continuing our series, Dr Andy Eaton asks what could be the underlying diagnosis causing this older woman to become dizzy and breathless? Post your answers below…
Note details of the case have been changed to ensure patient anonymity
A 74-year-old woman presents four months after her husband died suddenly from a pulmonary embolism. She has consulted with several colleagues in the interim, as she did not cope well following her bereavement, and became uncharacteristically anxious with associated dizziness and shortness of breath.
She has come in this time for a review of her sertraline, which a colleague started two months ago. She says she feels better mentally but her shortness of breath remains. She denies any chest pain.
She has type 2 diabetes and she is an ex-smoker.
She has had spirometry performed, which was normal.
Her most recent HbA1c was 78mmol/mol, and she admits her diet has slipped following her bereavement.
It is tempting to assign the shortness of breath to her anxiety. However, on further questioning, she then explains that she used to go for regular walks with her husband without difficulty, but is now so short of breath on exertion that she even has to stop half-way up the stairs.
This prompts a physical examination and a surprise discovery.
What do you think the surprise discovery is? And can you surmise the diagnosis? Post your answers in the comments below. Answer to be revealed in the coming weeks!
Dr Andy Eaton is a GP and GP educator in Somerset
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
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READERS' COMMENTS [4]
Please note, only GPs are permitted to add comments to articles
Irregular pulse due to AF?
Long-covid due to visiting husband in hospital?
Irregular pulse/AF is most likely, though hardly a “surprise “ clinical finding , so I’m having a side-bet on a harsh murmur suggesting Aortic Stenosis.
The sertraline clue means you might discover hyperreflexia due to serotonin syndrome., whilst a regular tachycardia might suggest her “anxiety “ was in fact undiagnosed hyperthyroidism.
A more humdrum finding of peripheral oedema would point to cardiac failure.
As to the relevance of the hyperglycaemia , you might hear the Rice Krispies popping of diabetes-induced (and smoking enhanced) pulmonary fibrosis, which can sometimes show a normal spirometry, but that’s a real long shot.
AF and HF are very likely but I bet on unndiagnosed Aortic Stenosis.
Pulmonary hypertension is another possibility as is interstitial lung disease.