TY - CHAP M1 - Book, Section TI - Respiratory Support Devices A1 - Dileep, Arundhati A2 - Sharma, Samin K. A2 - Vittorio, Timothy J. A2 - Saad, Muhammad PY - 2024 T2 - Devices in Cardiac Critical Care AB - Case PresentationA 65-year-old woman with hypertension, diabetes mellitus, and asthma presented to the emergency department with the acute onset of shortness of breath. Over the prior 6 months, she has had 3 similar presentations. Each time, she has been admitted and treated with diuretics and bronchodilators, with improved symptoms. She follows up in clinic regularly.On admission, her blood pressure is 156/88 mmHg and heart rate is 89 bpm. Her body mass index is 38 kg/m2. She appears to be in respiratory distress. Her jugular venous pressure is not visible due to body habitus. She has diffuse crackles in the lungs with 2+ pitting edema.Chest X-ray shows enlarged pulmonary arteries with bilateral infiltrates suggestive of pneumonia versus pulmonary edema. Echocardiography shows a small left ventricle with a sigmoid septum and an ejection fraction of 30%, borderline right ventricular dilatation, mild-moderate mitral regurgitation, and mild tricuspid regurgitation. Estimated right ventricular systolic pressure is 40 mmHg. She is started on intravenous furosemide and inhaled albuterol and ipratropium. Despite this treatment, she remains dyspneic, and subsequent laboratory studies reveal an increase in creatinine from 1.2 to 1.8 mg/dL. Her pro-B-type natriuretic peptide level was 1000 ng/dL. Blood gas showed pH of 7.10, PCO2 of 70 mmHg, PaO2 of 69 mmHg, and serum bicarbonate of 28 mmol/L. The patient was admitted to the coronary care unit for heart failure exacerbation and was initiated on bilevel positive airway pressure (BiPAP) for respiratory distress. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/11/11 UR - accesscardiology.mhmedical.com/content.aspx?aid=1207371362 ER -