A tall smoker
A 53 year old man, who was a heavy smoker, was admitted to hospital with shortness of breath at rest and a two week history of a productive cough. His medical history showed that he had never had any serious illness. He led an active life, playing cricket and football. He was slightly reticent when talking about his family. He visited his doctor, who prescribed a course of antibiotics. He failed to complete the course because he had not been sleeping well and felt “on edge.”
He later visited the emergency department and was diagnosed as having lower respiratory tract infection and anxiety attacks. He was treated accordingly. Three days after discharge, he deteriorated and entered the emergency department with acute palpitations, frothy blood tinged sputum, and frank haemoptysis.
Cardiovascular examination found a regular pulse at 108 beats/min, blood pressure of 140/72 mm Hg, and a temperature of 37.3°C. Jugular