Problem:
Patient is a 60-year-old female, referred to the cardiology clinic by her physician assistant for increasingly severe SOB. She denies angina pectoris. Symptoms first appeared five years ago following an acute episode of viral bronchitis. At the time, the SOB was attributed to the lung infection. However, symptoms continued to gradually worsen rather than improve. Adult-onset asthma and emphysema have been ruled out by a pulmonologist. At this time, the patient is experiencing severe SOB with mild activity. She has recently noticed swelling in her feet, and her PA has now diagnosed CHF, prescribed digoxin, and referred her to further diagnosis and treatment.