A 39-Year-Old Man With Epigastric Pain, Intermittent Chest Pain, and Progressive Dyspnea

摘要

A 39-year-old man presented to the emergencyndepartment with a complaint of progressive dys-npnea and intermittent chest pain over several months.nHis medical history was unremarkable except for anrecent workup for epigastric discomfort and early sati-nety. Results of esophagogastroduodenoscopy, gastricnmucosal biopsies, and testing for Helicobacter pylorinwere negative. The patient also had intermittent epi-nsodes of chest pain for which he underwent dobut-namine stress echocardiography. Pertinent findings in-ncluded mild dilation of the right ventricle and rightnventricular systolic pressures of 35 to 40 mm Hg. Thenpatient also admitted to daily marijuana use for the pastn20 years. In addition to his other symptoms, he re-nported an approximate 20-pound weight loss over thenpast year.