A Diagnosis at Hand: Pulmonary Arterial Hypertension

Abstract

A classic physical examination finding pointed to underlying disease in a 43-year-old Hispanic woman. On presenting to the Emergency Department, she reported progressive shortness of breath, fatigue, and chest pressure. One month earlier, she could exercise without limitation. However, in the ensuing interval, she developed increasing dyspnea and constant, nonexertional, left-sided chest pressure. A review of systems was notable for dysphagia. The patient denied palpitations, orthopnea, paroxysmal nocturnal dyspnea, or edema. She had no significant past medical or family history and denied tobacco, alcohol, or illicit drug use. An undocumented immigrant from Mexico, she had limited access to health care.