CASE STUDY:
72-Year-Old Male with Coronary Artery Disease and Exertional Dyspnea

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 72-year-old male presented in September of 2001 with exertional breathlessness and cough of approximately 6 months' duration. He first noticed severe dyspnea while walking the golf course and when this shortness of breath did not resolve, he sought medical attention from his primary care physician (PCP). His PCP obtained a chest radiograph, which demonstrated unspecified abnormalities and prompted a high-resolution computed tomography (HRCT) scan of his lungs and referral to the university interstitial lung disease (ILD) clinic.

He denied the presence of any constitutional symptoms including fever, chills, myalgias, arthralgias, arthritis, or muscle weakness and gave no history of gastroesophageal reflux disease (GERD).

MEDICAL HISTORY

The patient's medical history was notable for coronary artery disease (CAD), which led to a myocardial infarction and percutaneous transluminal coronary angioplasty (PTCA). His medications included metoprolol and enteric-coated aspirin for his cardiac condition and simvastatin for hypercholesterolemia.

SOCIAL HISTORY

The patient was a retired lumber and building materials salesman, yet denied any significant past exposure to environmental or occupational toxins. He did note that his home had a damp basement for which he employed the use of a dehumidifier. He is a former smoker and denied the use of alcohol or illicit drugs.

FAMILY HISTORY

The patient denied the presence of any interstitial lung diseases or connective tissue diseases in his immediate family members.

PHYSICAL EXAMINATION

On examination, the patient was a pleasant male, appearing his stated age and in no respiratory distress. His vital signs are listed below:

Examination of his head and neck was unremarkable. Auscultation of his chest revealed late inspiratory crackles at both lung bases. His heart had a regular rate and rhythm without murmurs, rubs, or gallops, and his abdomen was benign. There was no cyanosis, clubbing, or edema of the extremities.

LABORATORY AND SEROLOGIC TESTING

PULMONARY FUNCTION TESTS

PHYSIOLOGIC CLINICAL COURSE

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HIGH-RESOLUTION COMPUTED TOMOGRAPHY

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