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A.J. is a 58 year-old man that presents to your clinic with a chief complaint of increasing shortness of breath and an 8 kg weight gain. Two weeks prior he noted the onset of dyspnea on exertion after one flight of stairs, orthopnea, and ankle edema. Since then he has noted PND and has been able to sleep only in a sitting position. A.J. notes a productive cough, nocturia, and, dependent edema. PMH includes: Heartburn, OA managed with NSAIDS, depression, and HTN. Physical Exam: dyspnea, cyanosis, and tachycardia. VS: B/P 160/100 mmHg, Pulse: 90 beats/minute, Respirations: 28 breaths/minute. His neck veins are distended, S3 gallop is heard. PMI is at the sixth ICS
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