TY  - CHAP
M1  - Book, Section
TI  - Kidney in Heart Failure
A1  - McCullough, Peter A.
A1  - Panettiere-Kennedy, Katherine
A2  - Baliga, R. R.
A2  - Abraham, William T.
Y1  - 2018
N1  - 
T2  - Color Atlas and Synopsis of Heart Failure
AB  - A  75-year-old  woman  presents  with  effort  intolerance,  progressive  dyspnea  on  exertion  to  minimal  activity,  and  progressive  feet,  ankle,  and  lower  leg  swelling.  She  has  a  3-year  history  of  idiopathic  nonischemic  cardiomyopathy  with  a  left  ventricular  ejection  fraction  (LVEF)  of  35%  measured  within  the  last  year.  She  also  has  a  history  of  obesity,  type  2  diabetes  mellitus  for  15  years  with  diabetic  nephropathy,  and  hypertension  (HTN)  for  25  years.  The  medication  profile  includes:  furosemide  40  mg  orally  twice  a  day,  carvedilol  25  mg  orally  twice  a  day,  enalapril  10  mg  orally  twice  a  day,  and  glargine  insulin  60  units  subcutaneously  every  night  at  bedtime.  Vital  signs  were  blood  pressure  of  105/70  mm  Hg,  heart  rate  95  beats  per  minute,  respiration  rate  20  breaths  per  minute,  weight  82  kg,  and  body  mass  index  33  kg/m2,  temperature  98.4°F.  Her  physical  examination  reveals  jugular  venous  distention,  rales  one-half  of  the  way  up  posteriorly,  cardiac  enlargement,  an  S3,  2/6  murmur  consistent  with  mitral  regurgitation,  hepatomegaly  with  hepatojugular  reflux,  and  4+  pitting  edema  to  the  midtibia  bilaterally,  and  no  visible  rashes.  The  chest  x-ray  demonstrated  cardiomegaly  and  pulmonary  edema  and  the  electrocardiogram  revealed  normal  sinus  rhythm,  left  axis  deviation,  left  bundle  branch  block,  and  QRS  duration  of  120  ms.  Laboratory  testing  was  notable  for:  Na  =  133  mEq/L,  K  =  5.0  mEq/L,  creatinine  1.7  mg/dL  (estimated  glomerular  filtration  rate  [eGFR]  =  29  mL/min/1.73  m2),  BUN  =  48  mg/dL,  glucose  =  235  mg/dL,  glycohemoglobin  =  7.2%  and  B-type  natriuretic  peptide  =  2765  pg/mL.  The  urine  albumin  to  creatinine  ratio  was  315  mg/g.  The  patient  initially  received  furosemide  80  mg  intravenously  twice  a  day  with  a  good  diuresis,  but  on  the  third  hospital  day  the  creatinine  rose  to  2.9  mg/dL  and  the  urine  output  dropped  to  4  mL/kg  for  12  hours.  The  patient’s  pulmonary  examination  improved  somewhat;  however,  the  S3  and  peripheral  edema  were  essentially  unchanged.  The  managing  team  was  confronted  with  a  series  of  questions  regarding  the  differential  diagnosis,  prognosis,  and  next  management  steps.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesscardiology.mhmedical.com/content.aspx?aid=1161015605
ER  -