A 47-Year-Old Man Is Evaluated for Progressively Worsening Dyspnea on Exertion

A 47-year-old man is evaluated for progressively worsening dyspnea on exertion for several months.  The patient has frequent awakenings at night due to a choking sensation and feels tired all the time, limiting his physical activity.  He does not use tobacco, alcohol, or illicit drugs.  Blood pressure is 166/100 mm Hg and pulse is 80/min.  BMI is 48 kg/m².  Jugular venous pressure is difficult to assess due to neck fat.  Heart sounds are distant with no murmurs or gallops.  Bilateral breath sounds are normal with no crackles or wheezes.  Trace bilateral pitting edema is present.  Chest x-ray reveals poor inspiratory effort but clear lung fields.  Which of the following additional findings is most likely present in this patient?

A) Anemia due to low erythropoietin
B) Decreased chloride due to bicarbonate retention
C) Decreased pCO₂ due to persistent hypoxia
D) Decreased sodium due to increased antidiuretic hormone secretion
E) Increased BUN due to volume depletion

Correct Answer:

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