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Morbid Obesity: Obscuring the Diagnosis of Aortic Stenosis in a Patient with Cardiogenic Wheezing

  • Clinical Practice: Clinical Vignettes
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ABSTRACT

We report the case of a morbidly obese 65-year-old female who presented with repeated hypotensive episodes following dialysis. She was misdiagnosed as suffering from asthma, and eventually was found to have severe aortic stenosis. Obesity has become a common and formidable obstacle to gathering important diagnostic information in patients. Modern diagnostic lab tests and imaging modalities such as transthoracic echocardiography (TTE) can provide spurious data in the morbidly obese population, which can ultimately lead to misdiagnosis. In this clinical vignette, we discuss the relationship between the basic pathophysiologic mechanisms underlying aortic stenosis and patient clinical presentation. We also review the relevant literature and discuss the impact of obesity on the diagnosis of this condition.

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Acknowledgments

Contributors

Laura Townsend provided editorial assistance with this paper.

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The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Eric D. Morrell MD & Asher A. Tulsky MD

  2. Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    William E. Katz MD

  3. Division of General Internal Medicine, University of Pittsburgh Medical Center, UPMC Montefiore, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Asher A. Tulsky MD

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  1. Eric D. Morrell MD
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  3. Asher A. Tulsky MD
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Correspondence to Asher A. Tulsky MD.

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Morrell, E.D., Katz, W.E. & Tulsky, A.A. Morbid Obesity: Obscuring the Diagnosis of Aortic Stenosis in a Patient with Cardiogenic Wheezing. J GEN INTERN MED 28, 155–159 (2013). https://doi.org/10.1007/s11606-012-2155-9

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  • DOI: https://doi.org/10.1007/s11606-012-2155-9

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