MR. XYZ is complaining of shortness of

MR. XYZ is complaining of shortness of breath which started 24 hours ago, and increased lower swelling. He has mild, intermittent, left-sided substernal chest pain which does not radiate. A review of symptoms is positive for WT loss of 40 ls over the last 6 months, fatigue, malaise, general body aches, polydipsia, polyuria, chest pain, SOB, abd fullness, and lower extremity swelling. PM HX: Denies Surg Hx: denies Social Hx: Quit smoking 5 years ago but smoked 4 packs a day for 8 years. Denies ETOH and drug usage. Family Hx: Mother: had some type of cancer but does not know what kind, Parkinson’s disease, pneumonia Father: DM, CKD, & HTN Vitals: T98.6, HR 100, RR 26, BP 158/96, O2 sats is 92% on 2L NC Constitutional: A&O X3, obese, dyspneic mildly Head: normocephalic and atraumatic Eyes: PERRL, no nystagmus, no scleral icterus Neck: supple. 3cm of JVD presents bilaterally. No tracheal deviation was present. No thyromegaly or thyroid nodules noted Cardiovascular: normal rate, S1 normal, S2 present, s3 present, +2 edema in BLE Pulses: Brachial, Radial, DP, and PT are 2+/4+ bilaterally Pulm/Chest: Dyspneic, not using accessory muscles. Respirations are regular and even. Lungs with rales in the anterior and posterior lung fields bilaterally Abdominal: obese soft bowel sounds are active. Generalized tenderness. No masses were noted. No CVA tenderness. Unable to palpate liver due to body habitus. There is no rigidity, rebound, or guarding Lymph nodes: no cervical lymphadenopathy Neurological: CN II-XII intact Skin: skin is warm, dry, and intact Psychiatric: mood and affect normal. Calm and cooperative behavior. Judgment is intact. Meds: none After seeing Mr. XYZ you ordered several labs and tests, and some results are now available. Ast 60 units/L Alt 58 units/L Total Cholesterol 250mg/dl LDL 180 mg/dl HDL 15 mg/dl Triglycerides 275 mg/dl Troponin I 0.6 ng/ml LV EF 35% CXR shows cardiomegaly and Kerley Lines Echocardiogram: left ventricle ejection fraction of 35%, impaired left ventricular relaxation, left and right atrial hypertrophy, right ventricular hypertrophy, and pulmonary HTN Based on the current information available, what diagnoses do you believe Mr. XYZ has? What labs and/or diagnostic tests do you believe are needed at this time? Describe the pathogenesis which explains Mr. XYZ’s condition, his physical symtoms and diagnostic test results? What education is important for Mr. XYZ to receive?

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