Skill Checkup: A 62-Year-Old Black Male With History of Hypertension Experiences Mild Cognitive Impairment and Breathlessness

Jeffrey J. Hsu, MD


March 13, 2023

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

A 62-year-old Black male presents with mild cognitive impairment and breathlessness on minor exertion such as walking and normal daily activity. He is not symptomatic when at rest but reports that symptoms have been present on exertion for at least the past several weeks. He has a long-standing history of hypertension (for which he is taking diltiazem 180 mg daily) and was diagnosed with atrial fibrillation 2 years ago (which was treated with ablation). He is a nonsmoker. On examination, the patient appears fatigued. He also exhibited bilateral lower leg edema and neck vein distention. Body temperature is normal (98.1°F; 36.7°C). Blood pressure is 130/80 mm Hg. Lung examination reveals rales and wheezing. Rapid influenza and severe acute respiratory syndrome coronavirus 2 polymerase chain reaction tests are both negative. A range of lab tests is ordered. Complete blood cell count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, blood glucose, lipid panel, liver function test, iron studies, and thyroid-stimulating hormone are all in the normal range. An ECG is normal, but a chest radiograph shows an enlarged cardiac silhouette and edema at the lung bases.


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