Question

A 48-year-old man is brought to the ER complaining of difficulty breathing, fatigue, and intermittent chest pain for the past month. On further questioning, he states that the breathing seems to worsen when lying down. On physical exam, you note elevated respiratory and heart rates and pale, sweaty skin. On auscultation, rales are noted as well as a 3rd heart sound. Which of the following is the most likely diagnosis?

1 Right Ventricular failure
2 Pulmonary Embolism
3 Mitral Valve Stenosis
4 Left Ventricular failure
5 Chronic Obstructive Pulmonary Disease (COPD)

Answer 1

The likely diagnosis is left ventricular failure, indicated by symptoms of difficulty breathing, rales, and a 3rd heart sound suggesting pulmonary edema and ventricular dilation.

Step-by-step explanation:

The most likely diagnosis for a 48-year-old man who presents with difficulty breathing, fatigue, intermittent chest pain that worsens when lying down, elevated respiratory and heart rates, pale sweaty skin, rales, and a 3rd heart sound on auscultation is left ventricular failure. This diagnosis is supported by the presence of rales, which are indicative of fluid in the air spaces of the lungs, also known as pulmonary edema, and are commonly associated with heart failure. A third heart sound (S3) can suggest ventricular dilation, which is often seen in cases of left ventricular failure. Pulmonary edema can be life-threatening as it compromises gas exchange in the lungs, leading to difficulty breathing and potentially the chest pain the patient is experiencing. These symptoms are less indicative of the other listed conditions such as right ventricular failure, pulmonary embolism, mitral valve stenosis, chronic obstructive pulmonary disease (COPD), or pulmonary embolism.