Case report
A 74-year-old male with previous hypertension and myocardial infarction presented with light-headedness after walking down the stairs at home. He denied chest pain, but complained of shortness of breath on exertion. In the accident and emergency department he was noted to be pale and clammy. Initial observations were: regular pulse 88 bpm, blood pressure 127/81 mmHg, respiratory rate 20/min, and Sp02 95% (later consistently greater than 97%). He had stopped smoking aged 34 years.
On examination his chest was clear, the heart sounds were normal, the jugular venous pressure was not elevated and he had no peripheral oedema.
Initial e
