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(Circulation. 1996;94:1483-1488.)
© 1996 American Heart Association, Inc.

Articles

A 58-Year-Old Man With Shortness of Breath, Ascites, and Leg Edema

Itzhak Kronzon, MD; Matthew Fedor, MD; David Schwartz, MD; Gloria Gallo, MD; Daniel R. Jacobson, MD

the Department of Medicine and Pathology, New York (NY) University School of Medicine, and the Research and Medical Services (D.R.J.), New York (NY) Department of Veterans Affairs Medical Center. Presented August 25, 1995, at Bellevue Hospital, New York, New York.

Correspondence to Itzhak Kronzon, MD, Professor of Medicine, Director, Non-Invasive Cardiology Laboratory, 560 First Ave, New York, NY 10016. (Circulation. 1996;94:1483-1488.)

	Case Presentation (M. Fedor and D. Schwartz)

 
The patient is a 58-year-old African American man with past medical history significant for a positive purified protein derivative (PPD) 2 years ago. No treatment was given. He was in his usual state of good health until 6 weeks before admission, when he became aware of breathlessness on mild exertion. Over the ensuing 4 weeks, he noted progressive fatigue; swelling of his lower extremities, particularly on standing; and increasing abdominal girth. His exercise tolerance decreased until he could no longer walk a single city block comfortably. He denied chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. He also denied fever and significant weight loss but did complain of occasional night sweats. The patient was treated with furosemide 20 mg/d without improvement.

His family history was remarkable for a father and a brother who died of unknown heart disease in their 50s. He was married with one healthy son. He immigrated to the United States from St Croix 10 years before admission and worked as a mailroom clerk. He had no significant travel history, was a lifetime nonsmoker, and drank alcohol only socially.

Physical examination revealed an obese African American man in mild respiratory distress. He was afebrile. The heart rate was 80 bpm and regular, and his blood pressure was 120/70 mm Hg. Respiratory rate was 20 breaths per minute. His head was normal except for ill-defined hyperpigmentation periorbitally and bitemporally. His neck was supple without lymphadenopathy. Carotid upstrokes were normal. Jugular venous pressure was estimated at 14 cm . . . [Full Text of this Article]