CC: SOB

HPI: Patient complains of three days of intermittent shortness of breath which is worse with exertion and associated with lower extremity edema.

PFSH: Remarkable for hyperlipidemia, CAD and ischemic cardiomyopathy with EF of 25%. Non-drinker, previous smoker. FH is negative for hereditary cardiac disease.

ROS: Positive for orthopnea. No active chest pain. No PND, cough, nausea or vomiting. No fevers or chills. All other systems reviewed and are negative.

Exam: NAD, conversant. BP 160/80, RR 24, HR 98. HEENT: NC/AT. NECK: No JVD. LUNGS: Bibasilar crackles. HEART: RRR with S3 gallop. GI: Abdomen is soft with NABS. EXTREMITIES show bipedal edema.

Data: EKG was reviewed and showed some old Q waves in the anterolateral leads but no ST changes. CXR was reviewed and shows severe pulmonary vascular congestion. Labs show normal electrolytes, CBC and normal creatinine. Troponin is 0.08.

IMPRESSION

1. Severe CHF exacerbation
2. Poorly controlled HTN
3. Ischemic cardiomyopathy

PLAN

1. Admit to telemetry
2. Monitor enzymes
3. LASIX 40 mg IV BID
4. METOLAZONE 5 mg IV now
5. Echo in the a.m.
6. Increase LISINOPRIL to 40 mg PO QD

Click HERE to sign up to receive case of the week in your email.