Case presentation A 72-year-old man presents to the hospital complaining of several weeks of worsening exertional dyspnea. He feels short of breath after walking 100 feet. He does not have chest pain when he walks. He has been facing difficulty sleeping at night. Sometimes, he wakes up at night because of shortness of breath, which is relieved within minutes by sitting upright and dangling his legs over the bed. His feet have become swollen, especially by the end of the day. Medical history: None Examination : He is afebrile.
HR: 86 bpm. BP: 115/92 mm Hg. RR: 16 breaths per minute. Head and neck examination reveals pink mucosa without pallor, a normal thyroid gland, and distended neck veins. On examination, bibasilar inspiratory crackles are heard. Cardiac examination : His heart rhythm is regular with a normal S1 and a second heart sound that splits during expiration, an S4 at the…
