19th February 2025

A 56-year-old female presents to clinic with gradually worsening breathlessness over one year since she was diagnosed with an acute PE a year ago after starting hormone replacement therapy (HRT) for the menopause.

A 56-year-old female presents to clinic with gradually worsening breathlessness over one year since she was diagnosed with an acute PE a year ago after starting hormone replacement therapy (HRT) for the menopause. She was treated with 3 months of anticoagulation and her HRT was discontinued. Prior to the PE, she was able to walk 10 kilometres without stopping but over the past few weeks particularly she is only able to walk 200 metres without stopping. She mentions she also has noticed worsening leg swelling which is worse towards the end of the day. She denies any chest pain. She has no other significant past medical history or family history. She is a lifelong non-smoker.

On examination, her chest is clear, she has a right ventricular heave, the JVP is raised and she has bilateral pitting pedal oedema. She is saturating 94% on room air, HR 80 bpm, RR 20 breaths/minute, BP 128/70 mmHg.

What is the most likely diagnosis?

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