A 55-year-old male presented to urgent care with a chief complaint of coughing, shortness of breath, wheezing, chest palpitations, and dizziness for the past 2 days. The patient denied chest pain. He has a significant past medical history of diabetes mellitus II and takes metformin 500 mg once a day.

The patient’s blood pressure is 88/60 mmHg, heart rate is 115, O2 sat 98%, weight 275 pounds, BMI 50.3. In addition:

  • General: alert and oriented X3
  • Lungs: CTAB
  • Cardiovascular: tachycardic and regular without murmur, rub, or gallop
  • Abdomen: soft and non-tender, no pulsatile mass
  • Ext: 1+ pitting edema bilaterally in shins and ankles, pulses are equal and 2+ in all extremities

View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.


A 55-Year-Old Man with a 2-Day History of Respiratory Symptoms, Palpitations, and Dizziness

Sudhir Gogu, DO, PhD, MBA

Emergency Medicine Physician at Stone Oak Urgent Care
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