chf

CHF – Hypertensive Pulm Edema

MDM

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

CHF with Shock – Admit

MDM

This patient with a hx of ***CHF presents with acute shortness of breath and peripheral edema, most consistent with acute decompensated heart failure and concerning for cardiogenic shock. Likely etiology is medication non-compliance // dietary indiscretion // HTN // infection // fluid overload // anemia //alcohol intoxication // thyroid disease.*** I considered ACS as a possible etiology but think this less likely. EKG without overt evidence of acute ischemia. Other acute, emergent etiologies of shortness of breath are unlikely at this time.

Given tenuous systolic function and hypotension, plan includes starting ionotrope such as dobutamine +/- ionopressor (i.e. Dopamine, levophed). Will give O2; would like to avoid utilizing NIPPV or intubation due to tenuous preload status. Will require admission for acute management of ADHF.

Plan: labs, troponin, BNP, EKG, CXR, BUS, vasopressors, Cardiology consult***