Wiped Out

Abstract

An insidious process was depleting the endurance of a 75-year-old athlete. An avid runner, he presented to the emergency department with progressive dyspnea on exertion. At baseline, he could run 4 miles per day, but over the course of 2 months, he noted a gradual decrease in exercise tolerance secondary to shortness of breath. One month prior to presentation, his exercise tolerance decreased to 1 mile per day, and 2 weeks prior to presentation, he could run only one-quarter mile per day. The review of systems was negative for cough, chest pain, fevers, chills, night sweats, and weight loss. The Underdiagnosis of Pulmonary Hypertension in MyelofibrosisThe American Journal of MedicineVol. 123Issue 6PreviewI read with great interest the case of “wiped out” by Brastianos et al in the Diagnostic Dilemma Section of the Journal;1 however, I think the dilemma in the management of the symptoms of this patient still persists at the end of the discussion. The authors record that the patient notes an improvement in dyspnea with repeated blood transfusions. The lack of considerable improvement of the dyspnea might be related to underdiagnosed pulmonary hypertension. An echocardiography or cardiac catheterisation study should have been undertaken in this patient to exclude pulmonary hypertension, especially because computed tomography scan might not identify this complication. Full-Text PDF