Chest
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An 82-year-old man presented with 6 months of difficulties of falling asleep. He described a feeling of fading breath culminating in breathing arrest when he becomes drowsy. These recurrent events prevented him from falling asleep. ⋯ Medical history comprised several episodes of acute decompensated heart failure due to supraventricular tachyarrhythmia with need for hospitalization during the last 2 years. He additionally had two-vessel coronary artery disease with myocardial infarction, pulmonary hypertension, chronic atrial fibrillation, peripheral arterial disease, and chronic kidney disease (stage 3). Medication included diuretics, sodium bicarbonate, angiotensin II receptor antagonist, beta-blocker, statin, clopidogrel, and phenprocoumon without sedatives or analgesics.
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A 34-year-old man with history of β-thalassemia major and splenectomy presented with a 1-month history of progressively worsening dyspnea, orthopnea, localized chest discomfort, and lower extremity edema. He denied fevers, chills, nasal congestion, and night sweats. He denied tobacco, alcohol, and illicit substance abuse. Family history was remarkable for lung cancer in his mother.
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Right ventricular (RV) dysfunction is associated with shortened life expectancy in heart failure with preserved ejection fraction (HFpEF). The contribution of pulmonary vascular dysfunction to RV dysfunction in HFpEF is not well understood. ⋯ We conclude that RV-PA uncoupling is common in HFpEF and is caused by both intrinsic RV contractile impairment and afterload mismatch. Resting and dynamic RV-PA uncoupling in HFpEF is driven by an increase in RV pulsatile rather than resistive afterload. However, with the additive effects of increased RV resistive afterload, RV-PA uncoupling worsens dynamically during exercise.
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A 43-year-old woman with a medical history of cervical cancer treated with curative hysterectomy 12 years earlier developed progressive dyspnea, chest discomfort, and hoarse voice over a 7-month period. The patient never smoked and had no exposure history. ⋯ The patient was given the diagnosis of sarcoidosis and started on prednisone 60 mg daily. She had no improvement in symptoms after 3 months of therapy and therefore presented for a second opinion.