Editor—In the past 18 months two young sportsmen in their 20s have presented to our practice with breathlessness. Both were very fit but unable to complete the second half of their games; one played football, the other rugby. The first had some flitting chest pains; neither had any cough or haemoptysis. There was no history of recent foreign travel or immobility and no relevant family history, and they were not receiving drug treatment.
There were no positive findings on examination so they each had exercise pulse oximetry in the surgery. Being fit young men in their 20s they managed more than eight flights of stairs, after which their oxygen saturation was remeasured with a finger pulse oximeter. The result was a significant drop of oxygen saturation below 90% for at least one minute.
They started taking low molecular weight heparin in surgery, and ventilation-perfusion scans later confirmed the diagnosis of pulmonary embolism.
These cases show the usefulness of exercise pulse oximetry in primary care. It is not a sensitive test, but any desaturation is very likely to be due to clinically significant lung disease or shunting.
These cases also illustrate that pulmonary embolism can occur in people at apparently low risk and may be overlooked. Our first case had been assessed 24 hours earlier in a teaching hospital accident and emergency department (chest radiography and electrocardiography only), and a previous case in a young male student was diagnosed only after death.
Competing interests: None declared.