A 23-year-old student presents to her general practitioner (GP) complaining of shortness of breath on exertion. This has developed over the past 10 days, and she is now breathless after walking 50 yards. About 2 weeks ago she had a flu-like illness with generalized muscle aches and fever. She feels extremely tired and has noticed palpitations in association with her breathlessness. In addition, she has some discomfort in her anterior chest which is worse on inspiration. Previously she has been extremely fit with no significant past medical history. There is no recent history of foreign travel.
She denies substance abuse. Examination On examination, her temperature is 37.5°C. Her pulse rate is 120/min and regular. Blood pressure is 90/70 mmHg. Jugular venous pressure is raised at 8 cm. On auscultation, there is a gallop rhythm, with a third heart sound. Examination of her chest is…
