I can't lie flat anymore
Updated: Jun 9, 2020
67 yo F presented to the hospital with fatigue and inability to lie flat.
She has a history of hypertension, diabetes type II (Last A1c was 8.3%), obesity, gout.
She was in her normal state of health until approximately 1 month ago when she noticed some shortness of breath in the evenings when she would lie down. Was mild initially, but slowly progressed to the point where she was sleeping in her recliner. During the day she hasn't been too short of breath, however her activity level is limited.
She also noted her shoes and socks have been tighter than before. Denies chest pain, fevers, chills, nausea, vomiting or diarrhea. Unsure if she has gained weight, as she does not weigh herself.
T 98.3 HR 93 BP 113/76 RR 20 SpO2 93% on 2L
No acute distress
No lymphadenopathy, unable to assess JVD due to neck size
Tachycardic, no murmurs
Lung sounds distant
1+ pitting edema bilaterally
Unable to acquire good window in other cardiac views due to body habitus
What is the likely diagnosis?