Approach to dyspnea Quiz: Ace Your Exams
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A 62-year-old man presents to the emergency department due to three days of shortness of breath and difficulty lying flat. The patient has not seen a physician in twenty years and takes no medications. The patient smokes one pack of cigarettes per day. Temperature is 37.4 ºC (99.3 ºF), pulse is 90/min, blood pressure is 136/84, respiratory rate is 20/min, and oxygen saturation (SpO2) is 90% on room air. Cardiac auscultation reveals normal S1 and S2. Pulmonary auscultation reveals rales at both lung bases and faint wheezes in bilateral mid-lung fields. There is mild non-pitting edema in both feet. Electrocardiogram shows normal sinus rhythm with voltage criteria of left ventricular hypertrophy. Serum electrolytes and kidney function are normal. Chest x-ray shows mild pulmonary congestion. Which of the following diagnostic tests should be ordered next?
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