Case 9-1983

Presentation of CaseA 60-year-old man was admitted to the hospital because of increasing dyspnea.He was well until five years earlier, when angina pectoris developed. Thirty-nine months before admission the angina became more severe, and propranolol was prescribed. Because of profound fatigue isosorbide dinitrate was substituted, with satisfactory control of pain. He was then well and able to walk several miles daily until six weeks before entry, when he began to have exertional dyspnea outdoors in the cold and dyspnea on climbing stairs. Three weeks before admission a physician found crackling rales at both lung bases, without peripheral edema. . . .