RT Book, Section
A1 Monaco, James
A1 Haas, Garrie J.
A2 Baliga, R. R.
A2 Abraham, William T.
SR Print(0)
ID 1161018170
T1 Diuretic Therapy in Heart Failure
T2 Color Atlas and Synopsis of Heart Failure
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071749381
LK accesscardiology.mhmedical.com/content.aspx?aid=1161018170
RD 2024/04/19
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.