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The 'Jenesis' of a drug

27 year old female presents to the hospital with shortness of breath. She has no known past medical history, and was in normal health until about 1 month prior when she noted a gradual worsening of her shortness of breath to the point where going up a flight of steps would cause significant dyspnea.

She works in pharmaceutical sales. No recent long travel or car rides. Does not smoke or take birth control.

No chest pain, nausea, vomiting or diarrhea. Does note sometimes her feet swell after a long day of work, worse recently.


T 98.3 HR 88 BP 129/70 RR 14 SPO2 97 % breathing room air at rest


Gen: in no distress at rest, dyspneic with moderate exertion

CVD: regular rate, no murmurs

Lungs: No wheezing, some mild crackles at bases

Abd: soft, nontender

Extremities: no edema, erythema or unilateral swelling


Parasternal long:

Parasternal short:

Apical 4 chamber:

She had a CTA of her chest which was negative for pulmonary embolus. Lower extremity dopplers were negative for DVT.

What is the differential diagnosis?

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