Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this is a 60 year old woman who presents with the CC of cough over the past several months. The cough is worse in the morning. She notes increased shortness of breath with exertion as well. At the end of the day, her legs appear swollen. She denies fever, chest pain or chest congestion. She suffers from seasonal allergies and has occasional headaches. She denies recent travel. She has hypertension, which has been untreated, diabetes meliitus II treated with Metformin, and hypercholestrolemia treated with Simvastatin. No known drug allergies. Both mother and father had hypertension.
PE: Obese woman (BMI 33.3). Appears slightly short of breath. Vital signs BP 170/92, RR20, HR82, T98.2F. Cardiac exam reveals an S3. Lung exam has crackles present in lung bases bilaterally. 2+ pitting edema bilaterally to level of ankles.