72-year-old woman with obesity, hypertension, type 2 diabetes, and intermittent atrial fibrillation.
Complaint: progressive exertional dyspnea and reduced exercise tolerance for several months, with mild evening ankle swelling. History: no prior MI, BP often above target, no acute chest pain. Exam: mild bilateral ankle edema, lungs clear at rest, no distress, but limitation is clear with exertion.
Vitals: HR 82 · BP 154/88 · RR 18 · SpO₂ 96% (room air)
Labs: Echo: LVEF 60% with evidence compatible with abnormal diastolic filling · Natriuretic peptide elevated · renal function stable
What do you notice?
