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Eighty-nine-year-old woman with fatigue and reduced appetite
  1. Archana Selvakumar Thayaparan1,
  2. Deepak Haikerwal2,3
  1. 1 General Medicine, Western Health, Footscray, Victoria, Australia
  2. 2 Cardiology, Western Private Hospital, Footscray, Victoria, Australia
  3. 3 Cardiology, Western Health, Footscray, Victoria, Australia
  1. Correspondence to Dr Archana Selvakumar Thayaparan, General Medicine, Western Health, Footscray VIC 3011, Australia; archana.thayaparan{at}

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Clinical introduction

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 …

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