Diagnostic Strategy — The Shotgun versus the Arrow

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Abstract
A 72-year-old man came to the emergency room with recurrent shortness of breath and dizziness.The combination of shortness of breath and dizziness makes me think about a cardiac event, and the shortness of breath raises the possibility of heart failure. The dizziness suggests that the patient's cardiac output might be low. A disturbance of rhythm — either atrial or ventricular tachyarrhythmia — would be the first possibility I would be concerned about.The patient had a history of hypertension, non-insulin-dependent diabetes mellitus, and chest pain on exertion that was responsive to nitroglycerin and that occurred three . . .