Obesity and an Abnormal ECG

Abstract

A 44-year-old woman was evaluated for dyspnea on exertion, lightheadedness, and fatigue of two years' duration. The patient, who was 5 feet tall and usually weighed 150 pounds, had been overweight for many years. Four years earlier, she had enrolled in a weight reduction program that included drug therapy. She had lost 25 pounds during the first three months but nothing after that, even though she continued taking the antiobesity medication for two years. Her symptoms had begun with mild dyspnea, which she had attributed to obesity, but the dyspnea had become progressively severe.She was in no acute distress. Blood pressure was 129/75 mm Hg; pulse, 90 bpm and regular; respirations, 13 per minute; temperature, 37.0°C; and oxygen saturation 92% on room air. Jugular venous pressure was normal, the lungs were clear, and no ankle edema was present. Examination of the heart showed a loud second sound in the pulmonary area and a soft third sound at the left sternal border.The chest x-ray showed a normal heart size, prominent central pulmonary arteries, and clear peripheral lung fields. Hematocrit was 38%, and serum electrolytes, blood urea nitrogen, creatinine, and glucose levels were normal. The ECG is shown.