Symptoms: 6/10 substernal chest pain, shortness of breath.
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Write My Essay For MeVital signs: .4oF, , , /84.
Other: SaO2% on RA, 92% on supplemental O2. ECG showed normal sinus rhythm, no acute abnormalities.
Health history: Hypertension for 20 years. lbs. ”. Hyperlipidemia. 32 pack-year history of smoking. No personal or family history of diabetes or kidney disease. No family history of heart disease. Mr. Martin has a one-month history of progressive dyspnea on exertion, fatigue, abdominal bloating, and lower extremity edema. In the last week he has had 3 episodes of paroxysmal nocturnal dyspnea and orthopnea.
Medications: Hydrochlorothiazide 25mg po daily for last 10 years, simvastatin 20mg daily for last 5 years.
Examination: Mr. Martin was anxious at the time of examination. Jugular venous pressure (JVP) at 5cm above the clavicle. Point of maximal impulse (PMI) displaced laterally. S4, S3 audible. Systolic murmur 3/6, mitral valve regurgitation. Hepatojugular reflex (HJR) present. +1 pitting edema at mid-shin bilaterally.
Laboratory: BNP 1100pg/mL. Serial troponins negative. All other labs negative.
Radiology: CXR showed enlarged cardiac silhouette, mild pulmonary edema without effusion, and consolidation. Echocardiogram revealed left ventricular ejection fraction of 32% with dilatation and no wall motion abnormalities. Serial ECGs were normal.
Summary: Mr. Martin was admitted to a medical-surgical unit. He received diuretic therapy with improvement in his symptoms. BNP reduced to 200pg/mL and other labs remained stable. O2 normalized on room air. Mr. Martin had a 10-lb. reduction in body weight in 3 days. HJR was resolved and lower extremity edema was significantly improved. PMI lateral displacement remained. S3 resolved. 3/6 mitral regurgitation remained. JVP was at the clavicle.
Discharge medications: furosemide 20mg PO QD, lisinopril 10mg QD, simvastatin 20mg QDHS, carvedilol 3.125mg BID.
- What signs and symptoms might Mr. Martin have been aware of that could have indicated to him that he was having a health problem? In other words, what are the signs and symptoms of heart failure?
- What are the signs and symptoms that Mr. Martin came into the hospital with that were indicative of heart failure? Explain the physiology behind each sign/symptom; that is, what is the process that causes each symptom to manifest? For each sign/symptom that improved during his hospitalization, why did it improve?
- Could Mr. Martin’s previous medications have affected his heart failure? In what ways?
- Explain Mr. Martin’s other-than-normal examination findings. What is the physiology behind each? Why were his serial troponins negative?
- Describe how BNP measurements are used in the diagnosis and treatment of heart failure.
- Mr. Martin was discharged with a diuretic. Why was he not also started on potassium (first, why would he have been started on K+)?
- What assessments should be done at Mr. Martin’s first outpatient follow-up visit?
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