Correction: This article was updated on November 1, 2018, to add references.

Presentation

Mr M is a 72-year-old man with a past medical history of COPD and CAD with stent placement 10 years ago who presented to his primary care physician (PCP) complaining of increasing fatigue and dyspnea when lying flat. His symptoms have been slowly getting worse over the last few months. He denies waking from sleep gasping for air but has started sleeping with 2 pillows for comfort. Mr M confirms experiencing mild dyspnea with exertion. He has noticed occasional night sweating, bone pain, and despite reporting a decreased appetite, he reports a stable weight.  He denies dyspnea at rest, chest pain, heart palpitations, or cough. The patient does not have a known history of congestive heart failure. 

What diagnostic testing would be appropriate at this point?

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