Cardiovascular Risk in a Patient Applying to a Family Medicine Clinic with Shortness of Breath

Shortness of breath (dyspnea) is a critical symptom associated with increased mortality and morbidity, especially in patients with a high cardiovascular risk profile. Dyspnea may represent the initial manifestation of coronary artery disease (CAD) or heart failure, even in the absence of typical anginal chest pain. This case report presents an elderly male with multiple cardiovascular comorbidities and highlights the diagnostic and management challenges of dyspnea of unclear etiology. A 79-year-old man presented to the family medicine clinic with complaints of shortness of breath and orthopnea for the past 15–20 days. His heart rate was 110 beats/min, respiratory rate was 25 breaths/min, and blood pressure was 128/70 mmHg in the right arm. Echocardiography revealed a reduced left ventricular ejection fraction (LVEF) of 30% with systolic dysfunction and grade 1–2 mitral regurgitation. Electrocardiography demonstrated atrial fibrillation with a rapid ventricular response, and computed tomography revealed a thrombus at the left ventricular apex. The patient improved after diuretic therapy in the emergency department, and necessary consultations were arranged. Coronary angiography confirmed multivessel coronary artery disease (CAD); however, the patient refused coronary artery bypass grafting (CABG). Following acute decongestive therapy, the patient was managed with guideline-directed medical therapy and risk factor modification. Written informed consent for publication was obtained from the patient.