An Elderly Man With Dyspnea

Joshua M. Kosowsky, MD


October 28, 2014

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions.


A 65-year-old man presents to the emergency department with difficulty breathing. He describes worsening dyspnea on exertion that is associated with chest tightness, wheezing, and coughing. The patient's dyspnea has worsened to the point that he can hardly walk from his couch to the bathroom without becoming extremely short of breath. He recently recovered from a cold, with several days of nasal congestion, clear rhinorrhea, and a nonproductive cough.

The patient reports having been healthy his whole life and has not been to see a physician in at least two decades; however, he does admit that he has gradually curtailed his physical activities, such as gardening, shoveling snow, and walking in the mall, because he has been increasingly "getting winded." He smokes two packs of cigarettes daily, a habit he has been trying to break for at least 30 years.


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