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50 year old Indian man who presents with gradually and steadily…
50 year old Indian man who presents with gradually and steadily progressing breathlessness over the past 2 years
Cough?
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No wheezing
ILD. Other sx: fever; rapid and shallow breathing; exertional dyspnea; non-productive cough; PE: fine inspiratory crepitations; maybe clubbing; occupational (asbestosis, silicosis); hypersensitivity; drugs; MSK; idiopathic
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Pleural effusion. Other sx: occupational exposure; pleuritic pain; orthopnea; localized/decreased/absent breath sounds
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No cough?
Pulmonary hypertension. Refer to exertional dyspnea. Other sx: lethargy; fatigue; exertional chest pain
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Nature of dyspnea
Exertional, e.g. orthopnea/paroxysmal nocturnal dyspnea => Heart failure. Other sx: jugular vein distension; S3 gallop; pedal edema; bibasilar rales
Ischemia. Other sx: vasculopaths with multiple risk, e.g. HTN, DM, hyperlipidemia, smoking
Cardiomyopathy. Other sx: acquired with alcohol, chemo, viral, autoimmune
Hypertensive heart disease due to long-standing, poorly-controlled HTN => LV hypertrophy, failure.
Cor pulmonale. Other sx: check for pulmonary htn, e.g. loud P2, parasternal heave; right ventricular heave; murmurs; swelling in legs or abdomen (bilateral edema with abdominal swelling); primary or secondary pulmonary htn: fainting spells
Four major findings to suggest severity of cardiac dysfx: resting sinus tachycardia; narrow pulse pressure; diaphoresis; peripheral vasoconstriction