Description

SN is a 74-year-old male, presents with fatigue and shortness of breath for the past 2-3 months. He reports constant fatigue, dyspnea with minimal exertion, orthopnea requiring three pillows or a recliner, paroxysmal nocturnal dyspnea, a persistent dry cough following a recent cold, daily ankle and shin swelling that worsens by evening, and an unintentional 15-pound weight gain. He denies chest pain, fever, chills, sputum production, or dizziness. On examination, BP is elevated bilaterally (left 166/96, right 164/96, with HR 102, SpO2 91%. Heart sounds with S3 heard, PMI displacement, bibasilar crackles, JVD noted (5-6 cm), hepatojugular reflux, hepatomegaly, and 1-2+ pitting edema to the shins. Lungs clear of wheezing, and there is no calf tenderness or murmurs noted.