Congestive Heart Failure

HISTORY:

Congestive heart failure follow-up

Progress since last visit: ‍unchangedimprovedworsenedvariable in intensityresolved

Current symptoms:

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍shortness of breath

‍fatigue

‍decreased exercise tolerance

‍dizziness

‍palpitations

‍syncope

‍lower extremity edema

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍orthopnea

‍paroxysmal nocturnal dyspnea



Impact on daily activities: ‍minimalmoderateseveredebilitating

Overall quality of life: ‍goodaveragepoor ‍

Cardiac rehabilitation program: ‍completedenrolledabandonednot interested ‍



Social history:

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU

Caffeine: ‍ daily

Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss



Tests:

ECG: ‍ ‍normal

Echocardiogram: ‍ ‍unremarkable

Stress test: ‍ ‍normal

Coronary angiogram: ‍ ‍normal



Medications:

‍Aspirin, ‍clopidogrel, ‍statins, ‍Beta blockers, ‍ACE inhibitors, ‍ARBs, ‍Calcium channel blockers, ‍Nitrates

Adherence: ‍goodaveragepoor, ‍adverse effects



Vaccinations:

Pneumococcal: ‍up-to-dateincompleteunvaccinated

Influenza: ‍up-to-dateincompleteunvaccinated

Covid: ‍up-to-dateincompleteunvaccinated



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Measurements: weight: ‍ kg, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Heart failure ‍stable

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍BNP, ‍TSH, ‍LFTs

- Chest X-ray

- ECG

- Echocardiogram

- Home blood pressure monitoring

- Lifestyle counseling: ‍low sodium diet, ‍weight loss, ‍exercise, ‍smoking cessation, ‍alcohol moderation

- ‍ ‍Furosemide

- ‍ ‍Spironolactone

- ‍ ‍Beta-blockers

- ‍ ‍ACEs

- ‍ ‍ARBs

- ‍ ‍Sacubitril/Valsartan

- Referral to cardiologist

- Referral to cardiac rehabilitation program

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fainting

- Go to ER if severe chest pain, severe shortness of breath, or fainting occurs