A 56 year old man presents with 2 months of worsening dyspnea on exertion.  Now he can’t even go up the stairs without getting severely short of breath.   There is no fever, cough, chest pain, leg swelling or other symptoms.  He has no past medical history and his only medication is a steroid cream for a skin condition.

On exam he is afebrile with a pulse of 108, a BP of 118/70, respirations at 20, and a pulse ox of 94% at rest.  His lungs are clear without rales or wheezing, his heart is regular without murmur and his legs have no swelling, tenderness or cords.  The rest of his physical exam is normal.

His CXR & EKG are shown below.  What condition or conditions should you worry about and in what order.  Is his presentation “typical” or “atypical”?

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