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Cor pulmonale: variation on a theme
  1. O M P Jolobe,
  2. H J Schlayer,
  3. A Yates
  1. Department of Medicine for the Elderly, Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, UK
  1. Dr Jolobeandrea.hirst{at}exchange.tgcps-tr.nwest.nhs.uk

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Answers on p 675.

A woman aged 89 was admitted with a three month history of effort dyspnoea. She had had a previous admission, at the age of 86, for left lower lobe pneumonia, with coincidental atrial fibrillation.

On examination she was centrally cyanosed, normotensive, and had atrial fibrillation, pedal oedema, and raised jugular venous pressure to the angle of the jaw even when sitting up. A soft systolic murmur was audible at the left sternal edge.

Questions

(1)
What investigations would help to identify the underlying cause of cardiac failure in this patient?
(2)
Could there be a link between the atrial fibrillation and evolution of the changes in the QRS axis?

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