Congestive Heart Failure

Chief Compliant: The patient is a 50 year old white male with hypertension who complains of shortness of breath for 1 day.

History of the Present Illness: Duration of dyspnea; rate of onset (gradual, sudden); paroxysmal nocturnal dyspnea (PND), orthopnea; number of pillows needed under back when supine to prevent dyspnea; dyspnea on exertion (DOE); edema of lower extremities. Exercise tolerance (past and present), weight gain. Severity of dyspnea compared with past episodes.

Associated Symptoms: Fatigue, chest pain, pleuritic pain, cough, fever, sputum, diaphoresis, palpitations, syncope, viral illness.

Past Medical History: Past episodes of heart failure; hypertension, excess salt or fluid intake; noncompliance with diuretics, digoxin, antihypertensives; alcoholism, drug use, diabetes, coronary artery disease, myocardial infarction, heart murmur, arrhythmias. Thyroid disease, anemia, pulmonary disease.

Past Testing: Echocardiograms for ejection fraction, cardiac testing, angiograms, ECGs.

Cardiac Risk Factors: Smoking, diabetes, family history of coronary artery disease or heart failure, hypercholesterolemia, hypertension.

Precipitating Factors: Infections, noncompliance with low salt diet; excessive fluid intake; anemia, hyperthyroidism, pulmonary embolism, nonsteroidal anti-inflammatory drugs, renal insufficiency; beta blockers, calcium blockers, antiarrhythmics.

Treatment in Emergency Room: IV Lasix given, volume diuresed. Recent fluid input and output balance.

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