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Case presentation SL was a 44 year old Caucasian male with a past medical history of severe morbid obesity (BMI 99), heart failure with preserved ejection fraction, oxygen-dependent obesity hypoventilation syndrome (OHS), chronic non-healing leg wounds, anemia, uncontrolled hypertension on 2 anti-hypertensive agents, limited mobility, and major depressive disorder who presented to an academic medical center for treatment of acute on chronic diastolic heart failure due to progressive dyspnea

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