Reference no: EM133602736

Question

A 55-year-old man presents to the primary care clinic to establish care. He states that he is healthy and takes no medications. He is an accountant and has not seen a doctor in years. Anamnesis. He was asymptomatic, nonsmoker, without any comorbidities and with a familial history free from cardiovascular events. His wife urged him to make this appointment because he is no longer able to go on morning jogs with her because of fatigue. He used to exercise regularly, but he has noticed reduced endurance over the last year that he has attributed to aging. Over the past few months, he has noticed shortness of breath when he walks two flights of stairs. He has also had trouble sleeping and is now requiring three pillows to stay comfortable at night. Objective examination. On examination, the patient`s temperature is 36,5°C, heart rate is 85 beat per minute, and has a blood pressure of 140/50 mmHg while sitting. An oxygen saturation on room air is 93%. Respiratory rate is 24 per minute. He is comfortable and able to move around the examination room without difficulty. Palpation of the carotid arteries reveals a "water hammer" pulse. His apical impulse is hyperdynamic and.