Case 1:

A 72-year old retired CTA bus driver has been under your care for hypertension and DM for the past 12 years. She presents to your office for a routine visit and complains of leg swelling, mild exertional dyspnea and 10-pound weight gain over the past month. She denies chest pain, orthopnea, PND, or nocturia. She does not smoke or use alcohol. Her current medications include Metformin 2000mg/day, Atenolol 100mg/day, HCTZ 25 mg/day, ECASA 325mg/day, ibuprofen 600 mg TID and Lisinopril 20 mg/day. She is able to walk 2 blocks before she starts to develop shortness of breath.

BP 170/100, RR 20, HR 66, T 98f

Gen:     Overweight AA female in no apparent respiratory distress

Neck:    JVP to angle of jaw, positive hepatojugular reflux

Lungs:   Dull at bases

CV:       S4 audible, PMI Diffuse in MCL 2/6 HSM at apex

Abd:      obese, without hepatomegaly

Ext:       Bilateral ankle edema present