Skill Checkup: A 65-Year-Old Man With Progressively Increasing Shortness of Breath on Exertion and Racing Heart Rate

Jeffrey J. Hsu, MD


November 29, 2023

A 65-year-old Hispanic man in the United States who is employed as a plant manager presents with complaints of progressively increasing shortness of breath on moderate exertion, which began approximately 2 weeks earlier. He denies chest pain but says he sometimes feels his heart racing, particularly in the evenings, which he attributes to drinking too much caffeine during the workday. He reports nocturia for the last three nights. The patient appears well nourished and in no obvious signs of distress. There is no orthopnea, sweating, nausea, or mental confusion. Physical examination findings include blood pressure of 150/70 mmHg, pulse rate of 90 bpm, normal body temperature, and mild edema in the ankles. A protodiastolic (S3) gallop is heard during cardiac auscultation. Prior medical history is unremarkable, and the patient has no significant comorbidities. A test for severe acute respiratory syndrome coronavirus 2 infection is negative.


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