Orthopnea

HISTORY:

Orthopnea for ‍ ‍hoursdays

Number of pillows: ‍, ‍incline of bedsitting upright

Onset: ‍gradualsudden

Pattern: ‍constant (every night)intermittent

Alleviating factors: ‍nonesitting uprightextra pillows, ‍effectiveineffective

‍paroxysmal nocturnal dyspnea

‍leg swelling, ‍rightleftsymmetrical

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍palpitations

‍syncope

‍dizziness

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored



EXAM:

General appearance: ‍well-appearing

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

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

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



ASSESSMENT:

‍Heart failure ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ECG

- Chest X-ray

- Blood work: ‍CBC, ‍D-dimer, ‍troponin, ‍BNP, ‍blood gas, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH

- Echocardiogram

- Cardiac catheterization

- Pulmonary function tests

- Sleep study

- ‍Diuretics

- Fluid restriction

- Reduce salt intake

- Referral to pulmonologist

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if orthopnea worsens or if new symptoms develop such as chest pain, palpitations, or syncope