An Elderly Man With Dyspnea

Joshua M. Kosowsky, MD


October 28, 2014

Physical Examination and Work-up

On physical examination, the patient is alert but appears to be in mild respiratory distress, with moderate retractions and pursed-lipped breathing. He is afebrile. His blood pressure is 140/85 mm Hg; his pulse is 103 beats/min and mostly regular. His respiratory rate is 28 breaths/min, and a pulse oximetry reading shows 85% while the patient is breathing room air. His breath sounds are diminished throughout, with a markedly prolonged expiratory phase and faint expiratory wheezes in the upper lung fields.

The cardiac examination reveals distant heart sounds, with a somewhat prominent P2. He has no murmur, gallop, or pericardial rub. His skin is cool and dry. He has trace edema at his ankles, but no cyanosis or clubbing. An ECG is performed (Figures 1 and 2).


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