Get Answer: Case Exemplar Patient Question Guide
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Original Question
Case exemplar: Patient With Congestive Heart Failure HF is a 72-year-old black female who presents for a routine follow-up on her blood pressure. She has been noticing progressive fatigue over the past few months with shortness of breath with exertion. She lives in a two-story home with her bedroom upstairs, and it takes her about 10 minutes just to climb the stairs. Her laundry is in the basement, so she has been washing her clothes in the kitchen sink. She doesn’t really go out in public much lately because she gets so short of breath. She just sits at home and watches television. Past Medical History ï‚· Hypertension ï‚· Osteoarthritis ï‚· Depression ï‚· Cataracts ï‚· Hearing loss Medications ï‚· Hydrochlorothiazide, 25 mg once daily ï‚· Multivitamins ï‚· Acetaminophen for arthritis Social History ï‚· Lives alone, drives, prepares own meals; gets groceries delivered by her church ï‚· Nonsmoker, nondrinker ï‚· Retired nurse Physical Examination ï‚· Well-developed overweight female in no distress ï‚· Height: 64 inches, weight: 180 lb; blood pressure: 210/92; pulse: 84; respiration rate: 16 ï‚· Lungs: bibasilar rales; dullness to percussion right lower lung field ï‚· Heart: regular; grade III/VI systolic murmur with II/VI systolic murmur left lower sternal border; S3 present ï‚· Abdomen: soft ï‚· Extremities: 3+ pitting edema to the knees Labs and Imaging ï‚· Hemoglobin: 12.2 g/dL ï‚· Electrolytes, renal functions, liver functions: normal ï‚· Thyroid-stimulating hormone: normal ï‚· EKG: normal sinus rhythm; left ventricular hypertrophy with strain pattern; no acute changes ï‚· Chest x-ray: cardiomegaly; small right pleural effusion; pulmonary vascular congestion Discussion Questions 1. What are HF’s risk factors for heart failure? 2. What medications would be helpful for HF’s heart failure? 3. What medications would be safe and effective for HF’s hypertension?
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