A 66 year old male presents to your office complaining of shortness of breath for the past five days which has gotten progressively worse. His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure.

A 66 year old male presents to your office complaining of shortness of breath for the past five days which has gotten progressively worse.  His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure.