He now presents with increasing leg edema as well as shortness of breath. He does not have chest pain. His neck veins are distended. His liver is firm and the spleen tip is also palpable on physical examination. An 18 year old male is noted on physical examination to have marked bounding pulses in the upper extremities, but only weak pulses palpable in the lower extremities.
Pulmonary function is normal.
He does not have cyanosis.