Congestive Heart Failure
Patient Presentation:
L.Y., a 27 year old female presents to the emergency department with a chief complaint to the triage RN of shortness of breath and a productive cough with pink-tinged sputum for one week. The patient’s breathing is labored and breath sounds are diminished bilaterally in the lung bases. At triage, the patient reports no past medical history and no other complaints. The patient also mentions to the triage RN that she is 8 days status-post cesarean section. Initial Vital Signs: BP 138/90, HR 84, RR 28, O2 Sat 94% on RA, Temp. 98.4.
Differential Diagnosis:
Pulmonary embolism, congestive heart failure
Diagnosis:
The patient had an EKG upon arrival to the ER, showing NSR with marked left ventricular hypertrophy. Labs were obtained (CBC, CMP, ProBNP, D-Dimer, Troponin, CK, PT/PTT/INR, and urinalysis), an 18 gauge IV was placed, and a STAT chest x-ray and STAT CT scan of the chest were ordered at triage.
The patient’s labs showed a significantly elevated D-Dimer (2.85) and a significantly elevated ProBNP level (750). All other lab results were within normal limits. The patient’s chest x-ray showed an enlarged heart and bilateral pulmonary edema. The CT scan of the chest was negative for a pulmonary embolus, but did confirm the x-ray findings of an enlarged heart and bilateral pulmonary edema.
Treatment:
In the emergency department the patient was placed on continuous cardiac monitoring and 2L O2 via nasal cannula. The patient was medicated with IV Lasix®. The patient was diagnosed with CHF and admitted to the hospital’s cardiac center for further evaluation including an echocardiogram, stress test, and serial x-rays, EKGs, and labs.
Outcome:
The patient was discharged from the hospital after 2 days with prescription medications, dietary recommendations, and referral to a cardiologist for follow-up care.