Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially afte
Posted: Mon May 23, 2022 12:57 pm
Michael, age 62, is a male who is new to your practice. He is
reporting shortness of breath on exertion, especially after
climbing steps or walking three to four blocks. His symptoms clear
with rest. He also has difficulty sleeping at night (he tells you
he needs two pillows to be comfortable). He tells you that 2 years
ago, he suddenly became short of breath after hurrying for an
airplane. He was admitted to a hospital and treated for acute
pulmonary edema. Three days before the episode of pulmonary edema,
he had an upper respiratory tract infection with fever and mild
cough. After the episode of pulmonary edema, his blood pressure has
been consistently elevated. His previous physician started him on a
sustained-release preparation of diltiazem 180 mg/d.
Medical History:
His medical history includes moderate prostatic hypertrophy for
5 years, adult-onset diabetes mellitus for 10 years, hypertension
for 10 years, and degenerative joint disease for 5 years.
Medications:
His medication history includes hydrochlorothiazide
(HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d,
controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d,
and indomethacin (Indocin) 25 to 50 mg three times a day as needed
for pain. While reviewing his medical records, you see that his
last physical examination revealed a blood pressure of 160/95 mm
Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral
pulses, mild edema bilaterally in his feet, a prominent S3 and S4,
neck vein distention, and an enlarged liver.
Diagnosis: Heart Failure Class II
reporting shortness of breath on exertion, especially after
climbing steps or walking three to four blocks. His symptoms clear
with rest. He also has difficulty sleeping at night (he tells you
he needs two pillows to be comfortable). He tells you that 2 years
ago, he suddenly became short of breath after hurrying for an
airplane. He was admitted to a hospital and treated for acute
pulmonary edema. Three days before the episode of pulmonary edema,
he had an upper respiratory tract infection with fever and mild
cough. After the episode of pulmonary edema, his blood pressure has
been consistently elevated. His previous physician started him on a
sustained-release preparation of diltiazem 180 mg/d.
Medical History:
His medical history includes moderate prostatic hypertrophy for
5 years, adult-onset diabetes mellitus for 10 years, hypertension
for 10 years, and degenerative joint disease for 5 years.
Medications:
His medication history includes hydrochlorothiazide
(HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d,
controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d,
and indomethacin (Indocin) 25 to 50 mg three times a day as needed
for pain. While reviewing his medical records, you see that his
last physical examination revealed a blood pressure of 160/95 mm
Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral
pulses, mild edema bilaterally in his feet, a prominent S3 and S4,
neck vein distention, and an enlarged liver.
Diagnosis: Heart Failure Class II