An 80-Year-Old Man With Lightheadedness

Ryland P. Byrd, Jr, MD;  Ehab S. Kasasbeh, MD;  Jonathan W. Burress, DO

Disclosures

December 08, 2017

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 that you would like to suggest for a future Case Challenge, please contact us.

Background

An 80-year-old man is referred for a preoperative cardiac risk assessment before elective surgery for a hernia repair. He has no personal history of coronary artery disease or myocardial infarction, and no known family history of atherosclerotic heart disease.

The patient denies having any episodic chest pain and pressure, palpitations, nausea, vomiting, diaphoresis, or syncope. However, he describes some exertional shortness of breath that he attributes to a long history of habitual cigarette smoking, as well as an established diagnosis of chronic obstructive pulmonary disease (COPD).

In addition to the shortness of breath, he has also experienced brief episodes of lightheadedness from time to time. The lightheadedness occurs without warning and without any identifiable precipitating factor, and it abates without intervention. Other than his COPD, the patient has been remarkably healthy his whole life. His review of systems, other than as noted above, is negative.

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