Forward from: PHARMA PLUS TRAINING CENTER💊
Use the following to answer questions 2–4:
A 58-year-old man presents to the clinic today with complaints of increasing shortness of breath while dressing and carrying groceries and a 10 lb (4.5 kg) weight gain. A few months
prior, he noticed episodes of waking in the middle of the night with shortness of breath, difficulty breathing after walking two flights of stairs, as well as ankle edema. The patient has a history of osteoarthritis × 10 years, hypertension × 4 years, diabetes mellitus × 5 years, dyslipidemia, and is status post myocardial infarction 2 years ago.
Physical exam reveals the following: BP 148/96 mmHg, pulse 98 beats/min, Ht: 5’11’’ (180
cm), Wt: 189 lb (86 kg; usual = 178 lb [81 kg]), BMI: 26.4 kg/m2
(+) JVD, (−) HJR or hepatomegaly
(+) S3, (+) S4
ECG: regular rate/rhythm, evidence of old infarct
ECHO: EF 33% (0.33)
CXR: Crackles bilaterally and cardiomegaly (enlarged heart)
Labs:
Sodium: 142 mE/L (142 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)
Magnesium: 1.8 mEq/L (0.90 mmol/L)
BUN: 22 mg/dL (7.9 mmol/L)
SCr: 1.3 mg/dL (115 µmol/L)
BNP: 322 pg/mL (322 ng/L; 93 pmol/L)
Current medications:
Aspirin 81 mg daily
Diltiazem 180 mg daily
Glipizide 10 mg twice daily for diabetes
Simvastatin 20 mg nightly at bedtime
Acetaminophen 500 mg twice daily
A 58-year-old man presents to the clinic today with complaints of increasing shortness of breath while dressing and carrying groceries and a 10 lb (4.5 kg) weight gain. A few months
prior, he noticed episodes of waking in the middle of the night with shortness of breath, difficulty breathing after walking two flights of stairs, as well as ankle edema. The patient has a history of osteoarthritis × 10 years, hypertension × 4 years, diabetes mellitus × 5 years, dyslipidemia, and is status post myocardial infarction 2 years ago.
Physical exam reveals the following: BP 148/96 mmHg, pulse 98 beats/min, Ht: 5’11’’ (180
cm), Wt: 189 lb (86 kg; usual = 178 lb [81 kg]), BMI: 26.4 kg/m2
(+) JVD, (−) HJR or hepatomegaly
(+) S3, (+) S4
ECG: regular rate/rhythm, evidence of old infarct
ECHO: EF 33% (0.33)
CXR: Crackles bilaterally and cardiomegaly (enlarged heart)
Labs:
Sodium: 142 mE/L (142 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)
Magnesium: 1.8 mEq/L (0.90 mmol/L)
BUN: 22 mg/dL (7.9 mmol/L)
SCr: 1.3 mg/dL (115 µmol/L)
BNP: 322 pg/mL (322 ng/L; 93 pmol/L)
Current medications:
Aspirin 81 mg daily
Diltiazem 180 mg daily
Glipizide 10 mg twice daily for diabetes
Simvastatin 20 mg nightly at bedtime
Acetaminophen 500 mg twice daily