A 42 year old man with a history of hyperlipidemia obesity hypertension and type 2 diabetes mellitus is evaluated in the primary care clinic

A 42 year old man with a history of hyperlipidemia obesity hypertension and type 2 diabetes mellitus is evaluated in the primary care clinic with fatigue that has lasted for one year he states that about a year ago he changed jobs and was feeling very stressful adjusting to his new position eventually things settled down after a few months and he was able to perform better and worry less however the past eight months he has experienced fatigued throughout the day and that is unrelated to sleep or exercise. he also reports shortness of breath when he lays down and states that the shortness of breath is mitigating when he props his head up with silver pillows he also has shortness of breath walking a few steps but this stops when he is at rest he denies any other constitutional symptoms such as pain or rashes he denies any other constitutional symptoms such as pain or rashes in addition he also denies suicidal ideations guilt psychomotor problems or other mental health issues his medications are atorvastatin, metformin, and amlodipine. the patient’s temperature is 98.3 degrees Fahrenheit heart rate is 88 , RR is16 and blood pressure is 140/90 a