Exertional Dyspnea in a 76 YO Man

Physical Examination

  • General appearance: Thin, elderly male in no apparent distress.

  • Vital signs:
  • Temperature: 37.2° C
  • Pulse: 72 beats/min
  • Blood Pressure: 155/86 mm Hg
  • Respirations: 16/min

  • Skin: No rashes or cyanosis

  • HEENT: Nares patent, no discharge; oropharynx clear.

  • Neck: Jugular venous pressure 5 cm above the clavicle at 45 degrees. Delayed carotid upstrokes.

  • Pulmonary: Lungs are clear to auscultation bilaterally. No wheezes, rhonchi, or rales. No dullness to percussion.

  • Cardiovascular: Regular rate and rhythm, normal S1, diminished S2, crescendo/decrescendo systolic murmur heard best at the right upper sternal border radiating to the carotids. No rubs or gallops.

  • Gastrointestinal: Soft, nontender, nondistended. Normal bowel sounds are present in all quadrants. Rectal exam: Nontender, stool heme negative.

  • Genitourinary: Unremarkable

  • Extremities: 1+ pitting edema to mid-shin bilaterally, no tenderness or erythema. 1+ dorsalis pedis pulses bilaterally. Dialysis graft present on right forearm with good thrill.

  • Musculoskeletal: Unremarkable

  • Neurologic: Unremarkable

  • Mental status: Unremarkable