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This is a @AGE@ @SEX@ patient with history of ‍ sided, ‍ olic CHF, presenting with likely acute decompensated heart failure and ‍ pulmonary edema. The etiology of his decompensation is ‍ unclear but is likely due to ‍ . Alternative etiologies I considered include cardiac (ACS, valvular disease, arrhythmia, myocarditis/endocarditis, dissection), respiratory (COPD, PE, or PNA), medication noncompliance or dietary indiscretion, alcohol or drug abuse, endocrine (thyrotoxicosis), and anemia‍ . ‍ I considered ACS as a possible cause of the exacerbation but think this is unlikely given history and EKG without overt evidence of acute ischemia. Other acute, emergent etiologies of shortness of breath unlikely.



I plan for afterload reduction with nitrates given hypertension and possibly ACEi. Given respiratory status will also consider starting NIPPV. Will start diuresis after nitrate administration. The patient will require admission for acute management of ADHF.



Plan: labs, troponin, BNP, EKG, CXR, BUS, nitrates/diuretics, admission



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