What causes shortness of breath in an elderly person?

Posted on Tue, 17 Oct 2017 in Hypertension and Heart Disease
Question: what diagnoses would you give this patient? with the following situation. this is a case study.

A 78-year-old man is admitted to the hospital with the chief complaint of shortness of breath. He states the shortness of breath has been increasing over the past 2 months and is aggravated by exertion. He has found that he often awakens at night with a sensation of smothering that is partially relieved when he gets up and opens the window. He has not had ankle swelling or edema noted.

Past medical history is only positive for MI 8 years ago. He currently does not have complaints of chest pain.

BP is 140/98. When the nurse listens to his heart, she hears a normal S1 and S2 with a rate of 88. When listening to the lungs, the nurse notes bibasilar crackles. There is no peripheral edema.
Answered by Dr. Ilir Sharka 52 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that your symptoms seem to be relate heart failure, although there is no peripheral edema.

For this reason, I recommend consulting with your attending physician and performing some tests:

- a resting ECG and a cardiac ultrasound to examine your heart function and structure
- a chest X ray study
- NT-pro BNP levels for heart failure
- complete blood count
- kidney and liver function tests
- cardiac enzymes.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 28 hours later
Can you give a brief desprition of the pathophysiology of left-sided heart failure.
Answered by Dr. Ilir Sharka 10 hours later
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Regarding left-sided heart failure, you should know that the blood tends to remain in the pulmonary veins, as the left heart is not able to pump properly the blood collected from the pulmonary veins and the lungs to the aorta.

So, the main symptoms are those of pulmonary congestion (shortness of breath, especially during sleep or during physical exertion, cyanosis, orthopnea or shortness of breath during lying down position ), chronic fatigue, restlessness, confusion from low blood oxygen to the brain.

There is no peripheral edema (like in right sided heart failure).

But usually symptoms of left sided heart failure are overlapped to those of right sided heart failure.

Hope to have clarified some of your uncertainties!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ilir Sharka


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