The Case of the Portly Politician Who Couldn't Stay Awake

Albert Lowenfels, MD; Ashutosh Kaul, MD, FRCS

Disclosures

November 02, 2011

The Case

The patient was a male politician with a chief complaint of lethargy. He was about 6 feet tall and had obesity; the distribution was noted to be truncal. He became dyspneic with mild exercise. During the day, he noted excessive drowsiness; friends and coworkers observed that on occasion he apparently fell asleep during conferences or conversations. At night he snored loudly. As he grew older he developed angina, which, along with his shortness of breath, became more severe, and although he continued to work his symptoms required hospitalization on one occasion. Toward the end of his life, he was mostly confined to his house. A few days before his death he became semicomatose, and he died without showing any response to intravenous infusions.

Social and Medical History

There were no known familial illnesses. When the patient was 9, he had a skull fracture due to a wagon injury. As a young man, the patient drank and smoked cigars, but he give up both habits in midlife. He was married with children.

The patient had been obese most of his life. As an adult he had hypertension, with a systolic blood pressure of more than 200 mm Hg. Often weighing as much as 340 pounds, both his weight and his blood pressure fluctuated greatly throughout his life. He also had angina and atrial fibrillation, for which he received digitalis. He was diagnosed with gout leading to uric acid bladder calculi requiring cystoscopy. He had rectal abscesses requiring multiple operations.

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