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Case History: A 63 year old lady who lives alone with a cat is admitted with breathlessness. This has come on over the past day. She is usually active and can walk to the shops a half-mile away on the flat slowly. She had rheumatic fever as a child and so had to have a mitral valve repair 3 years ago for severe mitral regurgitation.
Her heart rate is 157/min and irregular. her SaO2 is 87% on room air. BP 145/90 mmHg. She has no chest pain. She has never smoked. She does have Type 2 diabetes on metformin and Hypertension and takes amlodipine.