A 52-year-old woman presents with 12 months of progressive breathlessness on exertion. She had a documented pulmonary embolism 18 months ago, treated with 6 months of anticoagulation which was then stopped.
Observations:
- BP 125/80 mmHg, HR 92 bpm, RR 18/min, SpO₂ 94% on room air
- Elevated JVP, loud P2 on examination
- Echo: RVSP 68 mmHg
- V/Q scan: multiple segmental perfusion defects
What is the most likely diagnosis and appropriate management?
A
Recurrent acute PE — therapeutic LMWH and urgent CTPA
B
Idiopathic PAH — vasoreactivity testing and targeted PAH therapy
C
Post-PE syndrome with normal pulmonary pressures - reassurance and pulmonary rehabilitation
D
Deconditioning — graduated exercise programme and physiotherapy
E
CTEPH — lifelong anticoagulation and pulmonary endarterectomy assessment