Cardiac physiology

Presentation: History

L.B. was well until 6 months ago, when he noticed extreme fatigue and lightheadedness when moving from a sitting or lying to a standing position. Initially, he blamed this on lack of sleep because of shortness of breath in bed, relieved by propping his head on two pillows, and frequent trips to the bathroom to urinate during the night. However, he recently found that he could no longer climb a flight of stairs without stopping to rest, and cannot complete chores around the house, such as laundry, mowing the lawn, and gardening. Additionally, when he tried to push himself to finish these tasks, he had episodes of chest “pressure” that were relieved by rest. Additionally, he notes, “It’s bizarre, but my boots sure feel tight at the end of the day. Ever heard of anything like that, doc?”

He has no known history of rheumatic fever. Although he has a remote history of smoking less than a pack of cigarettes per week, L.B. is not a current smoker and drinks infrequently. He has no history of hypertension, diabetes, high cholesterol, or heart disease. He admits it has been a few years since his last doctor’s appointment, but he thinks his physician might have mentioned a heart murmur before.