Case Report: DOE

History:

A patient in their early-60’s with no PMH presents to the hospital with 2 months of gradually worsening dyspnea on exertion that has been worse for the past few days. He thinks the trouble breathing may be an allergic reaction to a new skin cream he is using because the timing seems to fit. He denies syncope, palpitations, chest pain, leg swelling, or other complaints.

Exam:

Vital signs are as follows: Temp 98.8, BP 115/73, HR 112, RR 21, Sat 92%. Exam is otherwise normal with no rash, leg swelling, stridor, or wheezing/rales.

Testing:

CXR: clear with normal heart/mediastinum

An EKG is performed:

Computer Read: Sinus tachycardia at 109, cannot rule out inferior infarct of indeterminate age