Case Study: Uncovering the hidden causes of heart failure

Ian, 87, presents to an ED in respiratory distress. He was only discharged from hospital two weeks ago, after treatment for pneumonia.

chest pain

Ian is of Vietnamese background with limited English. Restricted history reveals he lives at home, is previously independent in activities of daily living, and has had several days of increasing breathlessness.

He is coughing, with limited sputum expectorated. He is an ex-smoker and has a history of COPD. He is on ventolin, atrovent and beclomethasone inhalers.

Examination
Ian is afebrile, with a

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