A 52-Year-Old Man With Progressive Dyspnea*
A 52-year-old white man comes to the office due to three weeks of progressive dyspnea and purulent sputum production. The patient takes albuterol and tiotropium bromide for moderate chronic obstructive pulmonary disease.
His medical history is relevant for a 40 pack-year smoking history, type II diabetes mellitus, hyperlipidemia, and coronary artery stenting two years ago. Physical examination shows barrel shaped chest, inspiratory crackles, hepatojugular reflux, pulsus paradoxus, and ventricular gallop.
His temperature is 100.5°F (38.1°C), the pulse is 130 beats/min, respirations are 28 breaths/min, blood pressure is 130/84 mm Hg, and pulse oximetry on room air shows an oxygen saturation of 86%.
Which of the following is the most likely diagnosis?
A. Cor pulmonale
B. Diastolic heart failure
C. High-output heart failure
D. Left-sided heart failure
E. Systolic heart failure
Answer to be disclosed shortly!
*The present case appears in Medscape.