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

Jeffrey J. Hsu, MD

Disclosures

February 10, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

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.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....