Year: 2023
Type: article
Study design: Case Report
Abstract: A 76-year-old man presented during the summer of 2021 with a 1-month history of progressively worsening exertional dyspnea and fatigue.He had previously been able to walk across a golf course without discomfort but now needed a golf cart, and he became breathless during light activities such as getting dressed.He reported no fevers, chills, night sweats, cough, chest discomfort, orthopnea, swelling of the arms or legs, weight gain, or bloody stools.He also had a new onset of headaches on awakening that were worse when he was in the supine position and abated with the use of aspirin, acetaminophen, and caffeine.Subacute dyspnea on exertion can be caused by cardiovascular and pulmonary disease, as well as by neuromuscular disorders, anemia, metabolic disturbances, and physical deconditioning.Characterizing the quality, triggers, and tempo of dyspnea can help to determine its cause.The subacute onset of air hunger is unlikely to represent new obstructive lung disease, but it could be a symptom of a wide variety of cardiovascular diseases including coronary atherosclerosis, arrhythmia, valvulopathy, heart failure, and pericardial effusion, as well as diseases of the alveoli, lung parenchyma, and pulmonary vasculature.New morning headaches in a patient older than 50 years of age that are worse when the patient is in the supine position merit neuroimaging to rule out a space-occupying lesion; however, headache in association with dyspnea might reflect multifocal infection or hypoxia in the context of cardiac or pulmonary disease.The patient's medical history included anal squamous-cell carcinoma that had been treated 12 years earlier with fluorouracil and mitomycin C, radiation therapy, and abdominoperineal resection.He subsequently had three episodes of genital cellulitis and began suppressive therapy with daily amoxicillin, which he had been taking for the past 10 years without recurrences.He also had hypertension, hyperlipidemia, and obstructive sleep apnea, for which he used a continuous positive airway pressure device on a regular basis.In addition to amoxicillin, his medications included daily aspirin, fexofenadine, gabapentin, losartan, simvastatin, and tamsulosin, as well as a daily multivitamin.He was a retired attorney who lived in the greater Boston area with his wife.He had never smoked cigarettes and had no pets.He had consumed at least 6 ounces of liquor daily for many years.Rectal cancer can metastasize to the lung and brain, and fatigue and headache could be symptoms of recurrent or new cancer.Hypertension and hyperlipidemia
Source: New England Journal of Medicine
Institution: Brigham and Women's Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4318763121