I agree he needs urgent evaluation with his worsening symptoms. The differential is broad for his various symptoms and will likely need cardiac, pulmonary and GI workup.
I agree. He should go straight to the most advanced ER/hospital local to him. A lot of things are probably going on.Once the more acute and scary things are sorted out I'd look into a sleep study to find out if he has sleep apnea since it can cause a cascade of serious problems.Also I do not mean to sound insensitive (and of course doing this is a very personal decision) but if obesity is a big problem for him he may want to consider weight loss surgery after he recovers from whatever is going on now. I was obese my entire life, once my health started failing I had gastric bypass surgery and I can't tell you how much it has helped me and probably saved my life.