A 72-year-old man presents to the office complaining of several weeks of worsening exertional dyspnea. Previously, he had been able to work in his garden and mow the lawn, but now he feels short of breath after walking 100 feet. He does not have chest pain when he walks, although in the past he has experienced episodes of retrosternal chest pressure with strenuous exertion. Once recently he had felt lightheaded as if he were about to faint while climbing a flight of stairs, but the symptom passed after he sat down.
He has been having some difficulty sleeping at night and had to prop himself up with two pillows. Occasionally, he wakes up at night feeling quite short 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. He denies any significant medical history, takes no…
