Presenting Complaints

• Fatigue, feeling easily tired with minimal exertion

History of Presenting Complaint

• Symptoms started gradually over the past 6 months
• Feels short of breath with climbing stairs or walking longer distances
• Occasionally experiences chest discomfort or palpitations, but these are not severe or persistent
• Denies any recent fever, cough, or other respiratory symptoms
• Symptoms seem to be worse with physical activity and improve with rest

Significant Positives & Negatives For Differentials

Coronary Artery Disease

Positives:

• Presence of risk factors (hypertension, smoking, family history)
• Symptoms of chest discomfort and shortness of breath with exertion
• Gradual onset of symptoms over 6 months

Negatives:

• Lack of severe or persistent chest pain
• Occasional rather than persistent nature of chest discomfort

Heart Failure

Positives:

• Symptoms of fatigue and shortness of breath, especially with activity
• Potential underlying condition like hypertension

Negatives:

• Lack of significant edema or other typical heart failure symptoms
• Relatively preserved exercise tolerance (able to perform daily activities)

Arrhythmia

Positives:

• Occasional palpitations reported by the patient

Negatives:

• Palpitations are not a dominant or persistent symptom
• No other signs of significant arrhythmia (e.g., syncope, dizziness)

Anemia or Other Medical Conditions

Positives:

• Fatigue as a predominant symptom

Negatives:

• Lack of other typical symptoms associated with anemia or other medical conditions
• Predominance of cardiovascular symptoms

Past Medical History

• Hypertension, diagnosed 5 years ago and controlled with medication
• No history of diabetes, high cholesterol, or heart disease

Drug/Medication History

• Hydrochlorothiazide 25mg daily for hypertension
• No other regular medications

Social History

• Works as an office manager, mostly sedentary job
• Married with 2 young children, lives in an apartment in Singapore
• Smokes 1 pack of cigarettes per day, drinks alcohol socially on weekends
• No recent travel history

Family History

• Father had a heart attack at age 55
• No other significant family history of cardiovascular or other chronic diseases

Systems Review

• Cardiovascular: Occasional chest discomfort, palpitations
• Respiratory: Shortness of breath with exertion
• Constitutional: Fatigue, decreased exercise tolerance
• All other systems review normal

Ideas, Concerns & Expectations

• Patient is concerned that his fatigue may be due to an underlying heart problem, given his family history
• He hopes the doctor can determine the cause of his symptoms and provide appropriate treatment

Case Presentation

The most likely diagnosis is some form of cardiovascular disease, such as coronary artery disease or heart failure. The patient's risk factors, symptoms, and lack of other significant medical history point towards an underlying cardiovascular condition as the primary cause of his fatigue and shortness of breath. Further testing, such as an electrocardiogram, echocardiogram, or stress test, would be necessary to confirm the specific diagnosis and guide appropriate treatment.