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A 59-year-old male presented to the emergency department with complaints of fever, cough, and progressive shortness of breath for the last 8 days. Initially, it began as flu-like symptoms with cephalgia, myalgia, and dry cough. Despite over-the-counter usage of acetaminophen and cough syrup, the symptoms worsened. Due to anorexia, he lost 8 lb. Additionally, he noticed pain and swelling in the right lower extremity. He works as a corporate counselor and has frequently traveled to Europe for business meetings and mentions his wife had similar symptoms, which improved after 1 week. The past medical history includes hypertension and hyperlipidemia, treated with lisinopril and atorvastatin, respectively. He denied any toxic habits. There was no past surgical history. On physical examination, he was noted to be in acute distress; tachypneic; and with dry, pale mucous membranes. The vital signs showed a blood pressure of 157/89 mmHg, heart rate 115 beats/min, respiratory rate 26 breaths/min, temperature 103.1°F, and SpO2 89% with an air flow rate of 4 L/min. Bilateral dry rales were noted diffusely over the lung fields. Tachycardia was present. There was a normal S1, increased P2, and grade II/VI holosystolic murmur at the lower left parasternal border. The right lower extremity was warm, tender, and edematous. The remaining physical examination was unremarkable (Table 5-1).
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The 12-lead electrocardiograms (ECGs) are shown in Figure 5-1A and B.
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Sinus tachycardia, left axis deviation, short PR interval, and ST-T wave changes in the precordial leads are suggestive of anterior wall ischemia and prolonged QTc interval.
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Chest computed tomography (CT) Scan
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Small bilateral effusions with near complete collapse of the right lower lobe. Nonspecific ground-glass opacity in the lingula may represent atypical pneumonia (Figure 5-2).
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Transthoracic echocardiogram (TTE) showed normal left ventricle size and systolic function. There was moderate tricuspid regurgitation with ...