CHF exacerbation
Patient Presentation:
R.E. is a 67 year old female who presented to the emergency department with complaints of shortness of breath and bilateral lower extremity edema. Patient stated she had noticed a 5 pound weight gain over the last week. Patient stated that she had run out of her “water pills” last week, and had not been able to refill them. Patient also stated that she has had to use 3 pillows to sleep at night due to the shortness of breath. On assessment patient had bilateral crackles throughout the lungs, and 3+ pitting bilateral lower extremity edema. Patients PMH included type 2 diabetes, hypertension, and congestive heart failure. Patient vital signs at triage were: HR 92, BP 152/84, Temp 37.7, RR 26, O2 saturation 84% on RA.
Differential Diagnosis:
congestive heart failure, pulmonary embolism, myocardial infarction, pneumonia
Diagnosis:
An EKG was done and showed NSR. Labs were drawn including a CBC, BMP, D-dimer, BNP, and cardiac enzymes. Chest X-ray was done and showed an enlarged heart with fluid in the lungs. CBC, BMP, and D-dimer were within normal limits. The BNP was elevated at 1400 pg/ml, and troponin was unremarkably elevated at 0.2 ng/ml. A transesophageal echocardiogram was done, and showed a EF of 30%. Patient was diagnosed with CHF exacerbation.
Treatment:
Patient was placed on 2L O2 per nasal cannula to keep O2 saturation greater than 95%. Patient was placed on continuous cardiac monitoring and continuous pulse oximeter. Patient was given IV furosemide and a Foley catheter was placed to closely monitor output. Patient was admitted to the telemetry unit for further observation and management.
Outcome:
Patient was discharged after 3 days with a CHF medication regimen including PO furosemide, a beta blocker, and an ACE inhibitor. Patient received education on sodium restricted diet, and follow up appointments with a local CHF clinic.