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An active, independent 89-year-old woman presented to her primary care physician with a 4-month history of fatigue, anorexia, exertional dyspnoea and weight gain. She had no chest pain, orthopnoea, paroxysmal nocturnal dyspnoea, symptoms of infection or blood loss. She had a history of colorectal cancer with a hemicolectomy 10 years prior. She had a dual chamber pacemaker, now in atrial fibrillation on warfarin. On examination her heart rate was 72 bpm, blood pressure 128/70mmHg and peripheral oxygen saturations 97% on air. Her chest was clear, jugular venous pressure was not elevated with only mild peripheral oedema. EKG showed atrial fibrillation with intermittent pacing. Blood tests …
Contributors Both AST and DH made substantial contributions to the conception and design of the work, and the acquisition, analysis and interpretation of the images, the drafting of the work and revising it critically for important intellectual content as well as final approval of the version published. Both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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