A 42-Year-Old Tennis Player With Dyspnea Blamed on Anxiety

Kennedy O. Omonuwa, MD


April 08, 2022

Physical Examination and Workup

Physical examination reveals an alert and oriented male with a regular pulse of 92 beats/min, blood pressure of 135/85 mm Hg, respiratory rate of 20 breaths/min, a temperature of 98.6°F (37°C), and an O2 saturation of 92% on room air. The neck is supple and without any jugular venous distention, lymphadenopathy, tracheal deviation, or thyroid nodules.

Cardiac examination reveals a normal S1, fixed split S2, and a prominent P2, but no audible murmurs, rubs, or gallops are noted. The chest examination shows bilateral equal air entry, without any wheezes, rhonchi, or rales. The abdomen is soft, nontender and nondistended, without any evidence of organomegaly. No lower extremity edema, cyanosis, or clubbing is seen. The peripheral arterial pulses are palpable. The neurologic examination is normal.

Laboratory investigations, including a complete blood count, comprehensive metabolic panel, B-type natriuretic peptide (BNP), and troponin are within normal limits.

Stool guaiac test findings are negative. Arterial blood gas on room air shows a pH of 7.48, a partial carbon dioxide pressure (pCO2) of 31 mm Hg, and a partial oxygen pressure (pO2) of 70 mm Hg. Chest radiography shows clear lung fields with prominent central pulmonary arteries. A 12-lead electrocardiogram (ECG) shows tall R waves in V1, inverted T waves in leads V1 to V4, II, II, and aVF. A CT angiogram of the chest is obtained (Figure 1).

Figure 1.


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