TY - CHAP M1 - Book, Section TI - Diuretic Therapy in Heart Failure A1 - Monaco, James A1 - Haas, Garrie J. A2 - Baliga, R. R. A2 - Abraham, William T. PY - 2018 T2 - Color Atlas and Synopsis of Heart Failure AB - A 51-year-old African American man presents to the emergency department (ED) with a chief complaint of dyspnea and swelling. He has a history of hypertension (HTN) and non-insulin-dependent type 2 diabetes. He works as a long-haul truck driver and reports not having seen a physician in over 3 years due to his work schedule and is no longer taking any home medications. He is saturating 93% on room air, has a pulse rate of 80 bpm, a blood pressure of 194/92 mm Hg, and a temperature of 36.5°C. Examination is remarkable for distention of the jugular veins, diffuse rales on inspiration, and 2+ pitting edema to midthigh. Initial electrocardiogram (ECG) shows left ventricular hypertrophy (LVH) by voltage criteria and left-axis deviation. A chest x-ray shows diffuse interstitial edema. Initial bloodwork is notable for a sodium of 135 mEq/L, creatinine of 1.1 mg/dL, albumin of 3.6 g/dL, hemoglobin of 12.9 g/dL, and brain natriuretic peptide (BNP) of 456 pg/mL. The patient receives oral hydralazine and intravenous (IV) nitroglycerin while in the ED with improvement of his blood pressure to 146/85 mm Hg, but he remains dyspneic with minimal exertion. A transthoracic echocardiogram reveals a hypertrophied left ventricle with moderately depressed left ventricular ejection fraction (LVEF) of 35% to 40% and grade II diastolic dysfunction. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesscardiology.mhmedical.com/content.aspx?aid=1161018170 ER -