Increasing shortness of breath

66-year-old white male Increasing shortness of breath over last month pt noticed feet and ankles swelling by end of the day Has occasional episodes of chest tightness Has been waking up in the middle of the night with acute shortness of breath Feels tired most of the time History of transmural anterior wall MI 7 years ago.

Triple vessel coronary artery bypass graft surgery 7 years ago . 2 pack/day smoker for 40 years; quit after bypass surgery. Positive family history of heart disease . The 15-year history of hypertension. No history of a cough. No palpitations.

Current medications: . meds at home: SL NTG pr; selective beta-adrenergic blocker once daily; and ASA 81 mg. BID. Height 182 cm Weight 82 kg BP 142/82 HR 84 RR 18 02 sats – 92% on RA Physical Exam: BP 110/60 (sitting); Apical Radial pulse 118 and regular; RR= 24 (increases with minimal activity, such as walking to exam room); T 37.2 orally; WT= 82 kg. HEENT, Skin, Neck . Eye exam by a physician is normal. Skin is pale; cool extremities. Neck supple, no bruits noted by the physician over carotid arteries. No history of thyromegaly, no adenopathy. Noted to have jugular venous distension (JVD)

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