A 35-year-old who had given birth around three weeks ago to her fourth child. She had normal deliveries with uneventful pregnancies. This time it was a home birth and both mother and baby were doing well until now. She presented with a three-day history of increasing shortness of breath. She also had some ankle edema and though she remembered her ankles being swollen during pregnancy they seemed to have become worse. Her last hemoglobin level was 10.1g/dl soon after having her baby and she was taking iron tablets.
On examination, she was apyrexial with clear lungs. Her cardiovascular examination revealed an S3 gallop rhythm and elevated jugular venous pressure. Her BP was 152/90mmHg with a pulse of 92 beats per minute. She was tachypnoeic and the pulse oximeter showed her oxygen saturation to be 90 per cent. She also had some bilateral pitting ankle edema but her calves were not tender…
