A Common Clinical Conundrum

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Abstract
A 60-year-old man came to the hospital because of intermittent wheezing, progressive dyspnea on exertion, and severe orthopnea, which had been present for several weeks. The patient had also had occasional vague chest pressure that was not clearly brought on by exertion. In the emergency room, the patient was short of breath while breathing room air; his oxygen saturation was 84 percent. On physical examination his blood pressure was 192/78 mm Hg. He had bibasilar rales, a gallop rhythm, and a right carotid bruit. The electrocardiogram showed no abnormalities, and the chest film demonstrated a normal heart size with . . .