A woman of 28 years presented with complains of worsening fatigue. She had given birth to her third baby three weeks ago. Her previous pregnancies and deliveries had all been uncomplicated and she had no significant medical history of note. She is obese; her BMI was recorded as 31.2 before her pregnancy. She smoked 10 cigarettes a day; before this pregnancy, she was smoking around 20 a day. Although she had expected to be tired with a newborn baby, she said the tiredness was far worse than she could ever imagine.
She had also noticed she had an occasional palpitation but otherwise felt well. At that consultation, her BP was recorded as normal. The doctor who saw her thought she might be anemic or hypothyroid, so he arranged for her to have some blood tests. She was found to have a tachycardia; her pulse was 138bpm. Auscultation of her chest revealed bibasal crackles and she was…
