Case presentation A 60-year-old woman with worsening dyspnea when resting presented to the emergency department. She had no fever, chest pain, expectoration, syncope, or constitutional symptoms.
Medical history · Nonsmoker · Morbid obesity · Poorly managed asthma · Hypertension · Type 1 diabetes · Diabetic nephropathy · Dyslipidemia · Chronic anemia Physical examination · Body mass index – 46 kg/m2 · Jugular vein distention · Imperceptible heart sounds · Vesicular breath sounds – Reduced on the left side of the chest
