Case 25 Cardiology

Dyspnea

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

A 70-year-old man presents with dyspnea. What do you notice when you first meet him?

Clue 2

This finding should generate a hypothesis, which we will circle back to eventually. Before we do, let’s talk about dyspnea. The two main systems responsible for dyspnea are the heart and the lungs.

Clue 3

The jugular venous pulse can serve as a pivot point. It can take you toward or away from the heart. With this in mind, let’s evaluate the patient’s neck. Here, he is in the upright position. (Sometimes the jugular venous pulse is better seen on the left.)

Clue 4

The JVP is elevated. We know we are dealing with something related to the heart.

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