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A 67-year-old male presented with shortness of breath, exacerbated by standing up and walking around and alleviated upon lying down. There was no associated coughing or chest pain. His medical history was notable for chronic alcohol abuse, chronic obstructive pulmonary disease and two recent admissions for aspiration pneumonitis. An inferior vena cava (IVC) filter had been placed 10 years earlier due to a pulmonary embolism. He denied illicit drug use. He was not taking any regular medications. On physical examination: T 97.6, P 100, BP 101/70, RR 30, O2 sat 95% supine and 91% upright on room air. He looked dishevelled, without respiratory distress. There was no jugular venous distention, and carotid pulses were brisk. Lungs were clear on auscultation. Heart sounds were normal without murmurs …
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