A 78-Year-Old Woman With Dyspnea on Exertion, Hypotension, and Telangiectasias

A 78-year-old woman with gastroesophageal reflux disease was admitted with 2 months of progressive dyspnea on exertion and leg swelling. At baseline, she could walk 10 blocks; at presentation, she managed less than 6 steps. For a month, she had been sleeping upright in a chair. She experienced no fever, cough, palpitations, or chest pain. With prompting, she shared a several-year history of discomfort and skin changes in her fingers; she attributed these symptoms to chemical exposures as a housecleaner.