A 68-year-old man with a recent diagnosis of mild heart failure comes to the office because of a 1-week history of dyspnea on exertion. He is relatively sedentary but is usually able to climb a flight of stairs without stopping. Now he must stop every few steps to rest because of dyspnea but not chest discomfort. He also complains of lower extremity edema, 2-pillow orthopnea, cough with occasional production of white phlegm, wheezing, and a 3-kg weight gain. He denies chest pain or discomfort, palpitations, syncope or near syncope. He has had no fever or upper respiratory symptoms. He states he has been compliant with his medications and denies any changes to his diet. He was seen by another physician two times in the past few months for similar symptoms; both times he had an ECG and chest x-ray and was told he had "mild heart failure." He was treated with an increased dose of furosemide without any other workup.
Next