Congestive Heart Failure
Patient Presentation:
L.W. a 66 year old female presents with a chief complaint of shortness of breath, fatigue, and a 20 lb weight gain over the last 6 weeks. The patient’s history includes hypertension, hyperlipidemia, and a hysterectomy 5 years ago. VS: BP 165/78, HR 118, RR 26, SpO2 94% on 3L NC, and Temp 36.9. Assessment consists of S1, S2, and S3 heart sounds, crackles bilaterally in bases of lungs, and 3+ pitting edema to bilateral upper and lower extremities.
Differential Diagnosis:
congestive heart failure, pulmonary embolism, thyroid dysfunction
Diagnosis:
Labs collected included: BMP, CBC, cardiac enzymes, liver function tests, thyroid function tests, BNP, d-dimer and urine analysis. IV access was obtained and an EKG showed sinus tachycardia. IV diuresis with furosemide was initiated.
X-ray showed cardiomegaly and fluid buildup in the lungs. CT was negative for PE. Echocardiogram showed ventricular hypertrophy with an ejection fraction of 35%.
Labs results included Na+ 130, BNP 750; all other labs were within normal range. The patient was diagnosed with congestive heart failure.
Treatment:
The patient was admitted for treatment and further diagnostics including trending labs, angiography, and a stress test. Pharmacological interventions included furosemide, lisinopril, nifedipine, and metoprolol. The patient was put on a cardiac (low sodium, low fat) diet with 1 liter fluid restriction and strict intake and output records initiated to monitor fluid balance.
Outcome:
After a 6 day hospitalization the patient’s fluid balance returned to normal. The patient was educated on the importance of diet and lifestyle habits in the progression of this chronic condition.