23 yo female p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs. No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?
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Daniel Dexeus, MD
Attending Physican
Gino A. Farina, MD, FACEP, FAAEM
farina@lij.edu
Residency Director, Department of Emergency Medicine
Associate Professor, Emergency Medicine
Albert Einstein College of Medicine
Matt Friedman, MD
mattsfriedman@yahoo.com
Attending Physician
FDNY EMS Fellow
Robert Gochman, MD
Attending Physician
Director Pediatric Emergency Medicine Fellowship
Pediatric Emergency Medicine
Jacob Goertz, MD, RDMS, FACEP
Director of Emergency Ultrasound
Assistant Professor, Emergency Medicine
Albert Einstein College of Medicine