Persisting Palpitations

You are asked to review her ECG to determine whether she can be streamed to the co-located GP.

List 2 abnormalities shown on her ECG (0.5marks each)

As you call her in from the waiting room to assess, you note she appears short of breath from walking 50 metres.

She has no past medical history and is taking no regular medications. She smokes daily and drinks alcohol at weekends. She is a regular runner and was able to complete 5 miles without difficulty until becoming ill 3 weeks ago.

She has not had any chest pain nor leg swelling. Aside from being a current smoker she has no other risk factors for ischaemic heart disease nor venous thromboembolism.

On examination her hear rate is 110 beats per minute, her lungs sound clear but you think you can hear a gallop rhythm. She does not appear to have any ankle oedema.

Suggest 2 investigations you would organise urgently within ED and provide your rationale for both. (0.5 marks each)

Her chest X-ray is shown.

1. What is the most likely cause of this abnormality in this patient? (0.5 marks)
2. Suggest one other possible diagnosis? (0.5 marks)