The effect of chewable isosorbide dinitrate on submaximal bicycle exercise capacity was evaluated in a double-blind randomized study involving 13 patients with chronic heart failure. All patients had impaired maximal exercise capacity (VO2 max = 12.0 +/- 2.6 ml/kg/min) due to fatigue and dyspnea but not angina. The administration of isosorbide dinitrate lowered the resting mean blood pressure (...

Hypersensitivity pneumonitis (HP) is an immune-mediated pulmonary disorder involving inflammation of the lung interstitium, terminal bronchioles, and alveoli caused by the immune response to the inhalation of an offending environmental airborne agent. It can manifest as exertional dyspnea, fatigue, weight loss, and progressive respiratory failure if left untreated. Because of its protean featur...

BACKGROUND Hepatopulmonary syndrome (HPS) is a pulmonary complication characterized by a triad of chronic liver disease, arterial hypoxemia, and pulmonary vascular dilations. Agitated saline contrast echocardiography is a simple inexpensive criterion standard procedure for confirming the diagnosis of HPS. CASE REPORT Here, we discuss a case of a 45-year-old male Indian patient with no medical...

Exercise-induced dyspnea (EID) is a common complaint in young athletes. Exercise-induced bronchospasm (EIB) is the most common cause of EID in healthy athletes, but it is important to recognize more serious pathology. Herein we present the case of an 18-year-old woman with a 1.5-year history of EID. She had been treated for EIB without relief. Her arterial oxygen saturation was 88% during exerc...

Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The nonpedunculated tumor involved most of the interatria...

A 31-year-old woman presented at a community hospital with an episode of hemoptysis at the 22nd week of pregnancy. She had experienced progressive exertional dyspnea since the first trimester of her pregnancy. Her medical history was notable for a “heart condition” diagnosed at birth for which the patient had never sought follow-up care. In the evaluation of her hemoptysis, her physicians perfo...

Systemic sclerosis (SSc)-associated interstitial lung disease (SSc-ILD) has become the leading SSc-related cause of death. Although various types of immunosuppressive therapy have been attempted for patients with SSc-ILD, no curative or effective treatment strategies for SSc-ILD have been developed. Therefore, management of patients with SSc-ILD remains a challenge. Here, we report a Chinese, f...

We describe a case of long-term administration of nitric oxide (NO) in a 32-year-old man who was admitted with exertional dyspnea and anasarca. A diagnosis of primary pulmonary hypertension was made. An acute vasodilator trial with inhaled NO showed a 5% reduction of the mean pulmonary artery pressure. Long-term NO inhalation therapy was initiated. Twenty days later, the dyspnea improved, the a...

Circulation. 2017;135:808–811. DOI: 10.1161/CIRCULATIONAHA.116.026903 808 ECG CHALLENGE A 59-year-old man presented to our hospital reporting 3 months of exertional dyspnea, ortopnea, paroxysmal nocturnal dyspnea, and lower leg edema. On physical examination, he had jugular venous distention, bibasilar rales, large tender liver, and peripheral edema. On cardiac auscultation, he had a regular he...