Case 1

A 31 year old woman was admitted with pulmonary oedema. Two months earlier she had complained of fatigue, palpitation, and chest discomfort. She had no risk factors for coronary artery disease, had regular menses, and denied smoking or alcohol consumption. There were no symptoms of intercurrent infection.

On physical examination she looked very ill. Her heart rate was 120 beats/min and blood pressure 130/80 mm Hg. She had a small goiter and typical signs of thyrotoxicosis including warm, moist skin and a fine tremor. There was an audible S3 on cardiac …