New-Onset LV Dysfunction

Abstract

A 50-year-old male with a history of hypertension (treated with diuretic therapy) for >10 years and a family history of early coronary artery disease (father with myocardial infarction in his late 1930s) presents with chest discomfort, rapid heart rate, and dyspnea. He has no history of recent viral illness, endocrine disorder, or family history of cardiomyopathy. His medications include hydrochlorothiazide 25 mg daily. There are no allergies. There is no illicit drug use. He consumes 3–4 beers every 2–3 days. His physical examination is significant for a temperature of 98.5 °F, blood pressure of 90/60, heart rate 140/min irregularly irregular, and normal respirations and oxygen saturation. He has jugular venous distension to the angle of the mandible, with normal carotid upstrokes. Apart from an irregularly irregular heart rhythm, he has an S3 gallop. No murmur is auscultated. His pulmonary examination demonstrates rales approximately one-half up the chest. There is no hepatosplenomegaly and the remainder of the abdominal examination is normal. He has 1+ edema bilaterally and his extremities are warm.