An 81-year-old female with a past medical history significant for hypertension, diabetes mellitus, and hyperlipidemia presents to the emergency room with complaints of difficulty breathing over the past 2 weeks. She was previously able to perform her housework without interruption, but now she finds herself requiring frequent rest breaks. She has been having more palpitations with these activities as well, but denies any chest pain, nausea, or diaphoresis. She also states her legs have progressively become more edematous bilaterally with an overall 5-pound weight gain over the last 1 week. She has had increasing orthopnea and is currently sleeping nearly upright in a recliner. Two days prior to presentation, she started developing paroxysmal nocturnal dyspnea.
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