1. A 65-year-old retired teacher is seeing a doctor for breathlessness over the past 2 years. He keeps himself busy with volunteer and social activities but has reduced his daily activities due to increased fatigue and breathlessness. 2. Over the past 6 months, he can only walk 3 times a week near his home before getting tired and short of breath. Any exertion causes chest discomfort and he has to rest. He also has a cough with white phlegm and swollen legs. 3. He has a history of heart disease and hypertension for which he takes regular medication. He sees his doctor regularly for checkups.

1. History1
65 year oldretiredteacher,marriedwith2children.He isbeingseenatthe outpatientclinicforthe
complaintof breathlessnessforthe past2 years.
Historyof presentingIllness
Althoughretired,he haskepthimself busywithvariousactivities.He isanactive memberof the
neighbourhoodcommittee whichorganisesvariouseventsinthe neighbourhood.Asaretired
teacher,he alsovolunteersatthe neighbourhoodschool toteachweakstudentsafterschool.He
oftenstartshisday walkingaroundthe nearbylake whichisabout2.5 km.He thengoesback fora
simple breakfastandsome gardening.Inthe afternoons,if he isnotteaching,he will be attending
meetingsordrive tothe seniorcitizensclubtomeetupwithhisfriends.
In the past 2 years he noticedthathe gets tiredeasilyandsometimesunable tocompletethe 2.5 km
as he gets breathless.Whenthishappens,he hastositdownon the park benchto rest.Once he had
to call hiswife topick himupat the lake as he was tootiredto walkhome.
For the past 6 months,hisdailymorningwalkshave beenreducedto3timesa week.Veryoftenhe
wouldgettiredandbreathlessafterwalkingabout500 metres.If he triestoexerthimself,he feelsa
slightchestdiscomfortandhe hasto stop and rest.He still doessome gardeningbuthasstopped
volunteeringatthe school ashe feelstootiredtoteach.At nighthe requirestwopillowsbefore
beingable tosleepcomfortably.Otherwise he wouldsuddenlywake upfeelingbreathless.He would
have to situp for about5 to 10 minutesbefore he feelsbetter.
The last 2 weekshe hasmovedtothe spare bedroomdownstairs.Thisisbecause he feelsbreathless
afterclimbingthe flightof stairs athome.He also hasa coughwithis productive of small amountof
whitishphlegm.He alsonoticedhislegsare constantlyswollenwhenbefore theywereswollenif he
walkstoomuch or stand fortoo long.
His appetite isasusual.There isnoobviousweightgain.He passesurine asusual andopenshis
bowelsdaily.Novomitingornausea.Sometimeshasheadachesbutgetsreliefwithpanadol.No
jointpainsor numbness.
Past Medical history
1. He has a heartproblemforthe past 5 yearsand ison medication.He wasadmittedtothe
hospital whenhe firsthadchestpains.He had itwhenhe was washingcarsduringa fund
raisingeventinthe neighbourhood.He wasinhospital for6 daysand had manytestsdone.
Doctor toldhimthat the bloodvesselstohisheartare narrowed.He was advisedtocontrol
hisdietand exercise routinely.Regularlygoesforhischeck-up.
2. He has hypertensionforthe last15 yearsand on medicationtoo.He takesa white tablet
everymorning.Nevermisseshismedication.
FamilyHistory

2. Both parentshave passedaway.Fatherdiedabout8 yearsago. He hada heartattack. Mother
passedawaylastyear because of oldage.She was 88 yearsold.He isthe eldestof 4 children. His
youngerbrotherhashighbloodpressure too.
He ismarriedwith2 children.Bothhischildrenare marriedandtheyare well.He has3
grandchildren.
Before retiringhe wasa secondarymathsteacher.He enjoyedteachingandstill keepintouchwith
some of hisstudents.
He usedto smoke about20 to 25 cigarettesaday for more than35 yearsuntil the doctoradvised
himto stop.He reducedthe numberof cigarettesbutcouldnotstop completelyuntil about6years
ago. He is a sociable personanddrinksabout3 to 4 cans of beerwhenhe was withhisfriends.But
nowhe drinksoccasionally.