A 51-year-old man with a history of angina reports intermittent breathlessness. Which medication is likely causing his symptoms?

In this scenario, the medication most likely responsible for the patient's intermittent breathlessness is atenolol. Atenolol is a beta-blocker commonly used to manage conditions such as hypertension and angina. While these medications are typically beneficial in controlling heart rate and reducing the workload on the heart, they are known to potentially cause respiratory symptoms, particularly in individuals with underlying conditions such as asthma or chronic obstructive pulmonary disease (COPD).

Beta-blockers can lead to bronchoconstriction due to their interaction with beta-2 adrenergic receptors in the lungs, which can result in symptoms such as wheezing and breathlessness. Although this is more commonly seen in non-selective beta-blockers, some patients can still experience similar effects even with selective beta-1 blockers like atenolol, especially if they have a heightened sensitivity or pre-existing respiratory conditions.

In considering the other medications listed, aspirin is an antiplatelet agent and is not associated with respiratory symptoms. Ramipril is an ACE inhibitor that primarily affects blood pressure but is not typically linked to breathlessness unless it causes side effects such as a cough, which is uncommon for most individuals. Omeprazole is a proton pump inhibitor used to reduce stomach acid and is not known