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ACP MKSAP Cardiovascular Medicine

A 27-year-old man is evaluated for a 3-month history of exertional dyspnea, which has progressed during the past week. Symptoms initially developed after recovery from an upper respiratory tract infection. He was treated with glucocorticoids for presumed postinfectious reactive airways syndrome without significant improvement. He reports that he slept in a chair last night because of the dyspnea. He has no other medical problems and takes no medications.

On physical examination, blood pressure is 110/68 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Oxygen saturation is 98% with the patient breathing ambient air. BMI is 39. Jugular venous distention is difficult to assess because of neck size. Auscultation reveals decreased breath sounds in the lung bases. Trace bilateral edema is noted.

ECG is normal. Chest radiograph shows bilateral blunting of the costophrenic angles.

Which of the following is the most appropriate diagnostic test to perform next?

A: B-type natriuretic peptide measurement
B: D-dimer testing
C: High-resolution CT of the chest
D: High-sensitivity cardiac troponin measurement

Answer and Critique

Back to the September 2026 issue of ACP Global