A 63-year-old retired radiologist was on vacation in Atlantic City. He had a mild upper respiratory tract infection approximately 1 week earlier. While in his hotel room, he noted the acute onset of orthopnea. He went to a local emergency room. In the ED, he reported orthopnea and dyspnea when bending over, but he could walk about two blocks on level ground. He denied cough, fever, wheezing, or sputum production. Review of systems was only notable for bilateral shoulder pain.