Skill Checkup: A 59-Year-Old Man With Dyspnea; Chest Tightness on Exertion; Leg Pain; and Lower-Limb Edema

Romesh Khardori, MD, PhD; Pamela Bowe Morris, MD


January 03, 2023

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

A 59-year-old Black man presents with a 6-week history of dyspnea and chest tightness with exertion. For 5 days, he has also experienced new-onset leg pain, particularly when walking and standing, as well as edema in the legs, ankles, and feet. He is a nonsmoker. He does not have a regular exercise regimen. The patient has delayed seeing his primary care physician for an annual physical and is overdue for bloodwork. His father died of an ischemic stroke at age 72 years with a history of atrial fibrillation. His brother was also diagnosed with atrial fibrillation at age 57 years.

On physical exam, his body mass index is 32.4; height is 5 ft 10 in (1.78 m), and weight is 226 lb (102.51 kg). There is a soft 2/6 crescendo/decrescendo murmur at the left sternal border without radiation. Carotid upstroke is normal. His blood pressure is 124/80 mm Hg. Lab results showed a total cholesterol level of 181 mg/dL, triglyceride level of 489 mg/dL, low-density lipoprotein (LDL) cholesterol level of 145 mg/dL, and high-density lipoprotein (HDL) cholesterol level of 36 mg/dL.


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