Reference no: EM133249797

A 66 year old male presents to your office complaining of shortness of breath for the past five days which has gotten progressively worse. His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure.

The patient has a history of diabetes, hypertension, and a prior myocardial infarction. His vital signs are: BP 208/102, HR 116, RR 28, T 98.4, 94% oxygen saturation. On exam you note rales in the lung bases bilaterally as well as 1+ pitting edema in the lower extremities bilaterally. The patient is sitting up and in no acute respiratory distress.

Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.