A 67-Year-Old Man Living Near Wildfires Presents for Yearly Wellness Visit

Case

A 67-year-old man living in the San Francisco Bay area presents for his yearly wellness visit. He has hypertension, diet-controlled diabetes, and hyperlipidemia. He is a former smoker with a 20 pack-year history. He has noticed some increased shortness of breath during the past several months that began shortly after the Sonoma-Napa wildfires but otherwise he feels well with no other new complaints.

Physical examination reveals clear lungs, normal heart sounds, no jugular vein distention, and some trace ankle edema unchanged from his prior visit last year. Laboratory results are normal. Electrocardiogram is unchanged from his baseline with mild nonspecific inferior and lateral T-wave abnormalities. He underwent an exercise nuclear myocardial perfusion imaging study in the previous year that revealed good exercise capacity for his age and no imaging abnormalities for ischemia or infarction.

Recently, he has read several news articles suggesting that living near the wildfires may have adverse health consequences. He wants to know how the exposure might affect him and what he should do to reduce his risk.

For which of the following conditions is he at an elevated risk?

A. Asthma and chronic obstructive pulmonary disease

B. Acute lower respiratory infections

C. Myocardial infarction

D. Stroke

E. Arrhythmias including sudden cardiac death

F. All of the above