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55yo female presents to your ED with a 1 month history of progressive dyspnea. She has a history of HTN and schizophenia, is on multiple antihypertensive medications (admits to “occasional” non-compliance) as well as Geodon (claims to be much better about taking this med than the others). Denies illicit drugs. Other than fatigue she really has no other symptoms including chest pain or fever and has an unremarkable exhaustive review of systems.
Afebrile, BP is 185/90, HR 72, RR 16, SpO2 97% RA. Other than 1+ edema in the LE’s her exam was unremarkable; of note, neck veins were difficult to assess because of her body habitus (obese), her lungs were clear and no murmurs were appreciated. Distal pulses were full and equal bilaterally.