Heart Failure Exacerbation

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍shortness of breathorthopneaedema

Symptoms include:

‍shortness of breath

‍edema

‍fatigue

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍decreased exercise tolerance

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍wheezing

‍nausea

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍palpitations

‍dizziness

‍syncope



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍non-adherence to salt intake restriction

‍non-adherence to fluid intake restriction

‍obesity

‍sedentary lifestyle

no history of: ‍congestive heart failure, ‍coronary artery disease, ‍arrhythmia, ‍hypertension, ‍diabetes

no use of: ‍beta blockers, ‍diuretics, ‍anticoagulants

‍non-adherence to medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Heart failure exacerbation ‍likelysuspectedpossible

DDx: acute decompensated heart failure, chronic heart failure with acute exacerbation, right heart failure, left heart failure, systolic dysfunction, diastolic dysfunction, high-output heart failure, cardiomyopathy, myocardial infarction, acute coronary syndrome, valvular heart disease, arrhythmias, pericarditis, tamponade, pneumonia, aspiration pneumonia, pulmonary hypertension, pulmonary embolism, anemia, renal failure, volume overload, medication noncompliance, dietary noncompliance





PLAN:

Investigations:

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

- Chest X-ray

- ECG

- Echocardiogram

Treatments:

- Low sodium diet

- Fluid restriction

- Regular exercise

- Smoking cessation

- Alcohol moderation

- ‍ ‍Furosemide

- ‍ ‍Spironolactone

- ‍ ‍Beta-blockers

- ‍ ‍ACEs

- ‍ ‍ARBs

- ‍ ‍Sacubitril/Valsartan

Further care:

- Home blood pressure monitoring

- Referral to cardiologist

- Referral to CHF clinic

- Refferal to cardiac rehabilitation program

- Follow-up in ‍ ‍weeksmonths

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

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