Never Stop Looking – the Heart is Not Always the Answer

Case presentation

A 63-year-old woman presented with a two-year history of worsening fatigue, dyspnea (World Health Organization functional class III), and palpitations. The echocardiogram had demonstrated a high probability of pulmonary hypertension (PH), and she was subsequently referred to a PH expert center. Her past medical history included systemic arterial hypertension, iron deficiency anemia secondary to gastrointestinal bleeding from duodenal telangiectasias (endoscopically treated), and a previous extraforaminal L3-L4 discectomy due to lumbar herniated disk with associated radiculopathy, performed at another hospital two years before the first appointment. The post-operative period was complicated by severe acute anemia of unclear etiology, which required nine red blood cell transfusions.

At the time of referral, the patient was taking furosemide 40 mg once daily (OD), candesartan 16 mg + hydrochlorothiazide 12.5 mg OD, simvastatin 20 mg OD, and alprazolam 0.25 mg OD. She had a history of smoking but no significant occupational exposures, and her family history was unremarkable.

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