Problem: A 58-year-old African-American woman presents complaining of worsening shortness of breath and palpitations for about 1 week. She reports feeling "dizzy" on and off for the past few months; the dizziness is associated with weakness that has been worsening for the past month. She has been feeling "too tired" to even walk to her backyard and water her flower bed that she used to do "all the time." She has been so dyspneic walking up the stairs at her home that she moved downstairs to the guest room about a week ago.