Case history 23 Amy Waters had to retire prematurely from her physically demanding job in 2002 when she was just 52 years old, because of worsening rheumatoid arthritis. Two years later she was given a hip replacement to increase her mobility. Post-operative recovery was complicated by an infection and on the tenth day following surgery she suddenly became extremely breathless. Understandably panicked, Amy also reported chest pain. During physical examination, the orthopaedic SHO noted some swelling of the left calf which Amy described as slightly tender when touched. A diagnosis of pulmonary embolus secondary to DVT in her left leg was eventually made. For the next few days Amy was given a continuous intravenous infusion of heparin and the breathlessness quickly resolved. After heparin was withdrawn Amy was prescribed warfarin tablets. She was eventually discharged home feeling well and delighted with her new hip. She was given a prescription to continue her daily dose of warfarin and asked to attend the haematology outpatients clinic every three weeks for a blood test.