Case Study- Management of Acute Decompensated Heart Failure in a 66-Year-Old Male with Comorbidities
Based on the symptoms and the assessment results, the most likely diagnosis for this patient is heart failure. Heart failure is the inability of the body to efficiently pump blood throughout the body. Symptoms include breathlessness after activity, swollen legs, dizziness, and fast heart rate (Inamdar & Inamdar, 2016). The patient has edema, a faster heart rate, respiratory rate, and low oxygen saturation rate. The causes of heart failure include hypertension and coronary heart disease (Inamdar & Inamdar, 2016). The patient has a history of hypertension and myocardial infarction.
The first differential diagnosis is chronic obstructive pulmonary disease (COPD). COPD presents with cough, exercise intolerance, chest pain, and dyspnea (Miravitlles & Ribera, 2017). The patient had coughs at night, shortness of breath, and chest pressure. However, he is not a smoker, and he has bilateral edema, which rules it out. The second differential is pulmonary hypertension. Symptoms include edema, palpitations, dyspnea, chest pain, and fatigue (Pesto et al., 2016). The third differential is pericardial disease. The patient’s symptoms of this condition include fatigue, exercise intolerance, and fatigue (Albugami et al., 2020).
The primary goals of heart failure will be to enhance prognosis, reduce mortality, and alleviate symptoms. The patient will be managed in an inpatient setup. His oxygen status will be managed. The patient will also be managed with diuretics to reduce pulmonary congestion and bilateral edema (Inamdar & Inamdar, 2016). The medication of choice will be hydrochlorothiazide. There will also be a salt restriction to lower fluid retention (Inamdar & Inamdar, 2016). The next medication the patient will be given is an Angiotensin-receptor blocker (ARB) to help vasodilation (Inamdar & Inamdar, 2016). The medication that will be given is Losartan 50mg.
References
Albugami, S., Al-Husayni, F., AlMalki, A., Dumyati, M., Zakri, Y., & AlRahimi, J. (2020). Etiology of pericardial effusion and outcomes post Pericardiocentesis in the western region of Saudi Arabia: A single-center experience. Cureus. https://doi.org/10.7759/cureus.6627
Inamdar, A., & Inamdar, A. (2016). Heart failure: Diagnosis, management and utilization. Journal of Clinical Medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062
Miravitlles, M., & Ribera, A. (2017). Understanding the impact of symptoms on the burden of COPD. Respiratory Research, 18(1). https://doi.org/10.1186/s12931-017-0548-3
Pesto, S., Begic, Z., Prevljak, S., Pecar, E., & Begic, N. (2016). Pulmonary hypertension – New trends of diagnostic and therapy. Medical Archives, 70(4), 303. https://doi.org/10.5455/medarh.2016.70.303-307
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Question 
-A 66-year-old male presents to your office complaining of shortness of breath for the past five days, which has progressively worsened. His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure.
Case Study- Management of Acute Decompensated Heart Failure in a 66-Year-Old Male with Comorbidities
The patient has a history of diabetes, hypertension, and a prior myocardial infarction. His vital signs are: BP 208/102, HR 116, RR 28, T 98.4, 94% oxygen saturation. On exam you note rales in the lung bases bilaterally as well as 1+ pitting edema in the lower extremities bilaterally. The patient is sitting up and in no acute respiratory distress.
Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.
Expectations
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
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