Loading...
Please wait, while we are loading the content...
Similar Documents
The Thrill Is Gone: A Case of Progressive Dyspnea.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Berry, Natalia C. Sobieszczyk, Piotr S. Beckman, Joshua A. |
| Copyright Year | 2015 |
| Abstract | 953 Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Beckman and Sobieszczyk), who respond to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows. A n 85-year-old white woman with longstanding atrial fibrillation and hypertension presented to our emergency department with a 2-day history of progressive dyspnea. Earlier that week she had been seen by an outpatient provider and was found to be hypotensive. Her home bumetanide was discontinued, and she developed dyspnea that progressed after missing 2 doses. She reported that she was sleeping with more pillows and that she had a limited ability to walk and a new cough. Her recent history was notable for progressive fatigue and dyspnea over the past year. In the past 3 months she had been treated as an outpatient with loop diuretics for presumed congestive heart failure by a cardiologist. Her recent history was also notable for recurrent hematoche-zia requiring 5 admissions, including an intensive care unit admission for hemorrhagic shock, over the preceding 6 months. An extensive evaluation, including esophagas-troduodenoscopy, several colonoscopies, and a small-intestine capsule study were unrevealing; she was noted only to have severe diverticulosis. During this period, her war-farin and, after additional bleeding episodes, her aspirin were stopped in light of her recurrent bleeding. Additional medical history included a diagnosis of cataracts, macular degeneration, and osteoarthritis. Medications included bumetanide 1 mg daily, metoprolol succinate 50 mg daily, omeprazole 40 mg daily, and calcium supplements. She had no known drug allergies. Dr Beckman: Dyspnea in an older patient is a common concern and is predominantly caused by a range of cardiopulmo-nary diseases. In this case, the patient's presentation is notable for progressive dyspnea over 1 year that has acutely worsened over several days. Her report of orthopnea, cough, and exer-tional intolerance suggest that an exacerbation of congestive heart failure is likely. Moreover, her diagnosis of congestive heart failure is only presumed, and further investigation is needed to understand this acute presentation. Other etiologies of progressive dyspnea include anemia related to her recent gas-trointestinal bleeding, or a primary pulmonary process such as interstitial lung disease, chronic obstructive pulmonary disease, malignancy, pulmonary hypertension, or an infectious process such as a viral respiratory infection or pneumonia. |
| File Format | PDF HTM / HTML |
| DOI | 10.1161/CIRCULATIONAHA.115.017267 |
| PubMed reference number | 26354783 |
| Journal | Medline |
| Volume Number | 132 |
| Issue Number | 10 |
| Alternate Webpage(s) | http://circ.ahajournals.org/content/circulationaha/132/10/953.full.pdf?download=true |
| Alternate Webpage(s) | https://doi.org/10.1161/CIRCULATIONAHA.115.017267 |
| Journal | Circulation |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
