Reference no: EM133444490

Question: A woman brings her 67-year old father to see the NP at the primary care clinic. The patient reports that he has experienced shortness of breath for the last two months that has continued to get progressively worse. He expresses great concern that this development has kept him from participating in his Silver Sneaker's program that he enjoys with his friends. He reports that he can barely walk a city block or walk up the stairs in his home without becoming short of breath. Upon exam, the NP notes a blood pressure of 180/58 mmHg and peripheral pulses are palpable at 4+. The cardiac exam reveals several murmurs: an early diastolic murmur that is high-pitched located loudest at the left lower sternal border; a diastolic rumbling sound heard at the heart's apex and a systolic crescendo-decrescendo murmur heard at the left upper sternal border. A chest x-ray is performed at the office and shows pulmonary edema and cardiomegaly.