Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.
Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping…