Shortness of breath in a 68 y/o man

• Medical history: Coronary artery disease diagnosed 18 years ago as "small heart attack" that was treated with percutaneous coronary angioplasty (PTCA). Paroxysmal atrial fibrillation and mitral regurgitation diagnosed 1 year ago, dyslipidemia, rheumatoid arthritis (RA), and monoclonal gammopathy of undetermined significance (MGUS).


• Surgical history: PTCA of the right coronary artery 18 years ago.


• Medications: Aspirin 81 mg once a day, atorvastatin 40 mg once a day, warfarin 5 mg once a day, furosemide 40 mg once a day, nitroglycerin 0.4 mg sublingually as needed.


• Allergies: No known drug allergies.


• Family history: Father had hypertension and type 2 diabetes mellitus. Mother died of breast cancer. No family history of premature coronary artery disease or sudden cardiac death.


• Social history: Patient is retired and lives with his wife. He has been able to do routine activities of daily living and has not had recent prolonged immobilization. He does not exercise, and he tries to follow a low-sodium diet. He consumes 1 to 2 alcoholic drinks per week. He denies illicit drug or tobacco use. No recent travel outside the United States and no known sick exposures.