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
