A 60-year-old man presented to an outside facility with hypercapnic respiratory failure requiring intubation and mechanical ventilation. He underwent diuresis for a presumptive diagnosis of congestive heart failure, was extubated, and was transferred to our university hospital for cardiac catheterization.
His dyspnea had been progressive over many years and was refractory to adjustments in his cardiac medications. A recent nuclear stress test showed reversible ischemia. He had a 20-year history of hypertension and diabetes mellitus with progressive nephropathy and retinopathy. He had a 100 pack-year smoking history and a remote asbestos exposure as a member of the Merchant Marine. Outpatient medications were rosiglitazone, 4 mg qd, quinapril, 10 mg qd, carvedilol, 6.25 mg bid, torsemide, 100 mg qd, metolazone, 5 mg qd, and timolol ophthalmic drops.