SOLVED640

A 65-year-old male presents to you in family practice clinic as a new patient to establish care with increasing shortness of breath over the last three months. He reports a 30-pack year history of smoking and a prior diagnosis of “high blood pressure, but I don’t take anything for it.” He denies having any other medical history and says “hospitals make me nervous.” He also reports having had a cough for “many years, started when I was younger and just never went away”. He decided to come to your clinic because he could no longer walk to the corner café, as is his normal routine, to have breakfast with his friends because he had severe wheezing and shortness of breath. He explains he is a veteran of the Vietnam War and being able to interact with his buddies is very important to him. Vital Signs: Temperature 98.6 degrees Fahrenheit Pulse 88 (irregularly irregular) RR: 22 BP: 160/95, no orthostasis SpO2: 95% on RA Medications: None, no routine prescription, OTC or herbal supplement use You are able to obtain some basic diagnostics in clinic: EKG: Atrial Fibrillation and changes consistent with left ventricular hypertrophy, no ST segment changes, otherwise normal EKG
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