ABSTRACT
History A 76-year-old man presents with a 2-week history of worsening shortness of breath on exertion and a 1-week history of a non-productive cough. He also notes that he has been having difficulty sleeping, often waking with fits of coughing and gasping for breath. His breathing difficulty has been present for the past six months initially on walking upstairs only, but for the past 2 weeks on walking flat surfaces for shorter distances. He has also noted some swelling of his ankles. He denies any other symptoms on direct questioning, in particular no chest pain or haemoptysis. He is currently on no medication. He has had a myocardial infarction in the past, but no other medical history of note.
