A 55-Year-Old Woman With Worsening Shortness of Breath

Stella Izuchukwu, MD, MPH

Disclosures

December 14, 2015

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. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 55-year-old woman with a medical history of congestive heart failure, hypertension, hyperlipidemia, asthma, gastroesophageal reflux disease, and lupus anticoagulant syndrome presents to the emergency department with severe, progressive shortness of breath that has lasted for the past 12 hours, with associated chest pressure and wheezing. She denies having any leg swelling, chills, sore throat, coughing, or heartburn.

Before reaching the emergency department, she used her albuterol inhaler without relief of symptoms and contacted emergency medical services. She has a 40–pack-year history of tobacco use, as well as a history of alcoholism (with her last consumption being 4 years before presentation) and remote marijuana use. Her medication regimen includes furosemide, fosinopril, isosorbide nitrate, pantoprazole, spironolactone, and enteric-coated aspirin, but she has a well-documented history of nonadherence.

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