Congestive Heart Failure Presenting as Shortness of Breath
Joseph Carter
Abstract
The case being presented is one of congestive heart failure that was diagnosed in the emergency
department. The clinical history and diagnostic findings are discussed.
1. Introduction
Congestive heart failure is a severe cardiovascular disease that when left untreated can increase the
chances of death. It is very common in the United States and affects millions of people, especially those
over the age of 65 [1]. Emergency physicians should maintain suspicion of congestive heart failure
when patients show symptoms of pneumonia.
Risk factors for developing CHF are age, obesity, history of heart attacks, and congenital heart defects;
the main risk is age and it increases as people get older and the heart muscles weaken [2].
2. Case Presentation
An 88-year-old male presented due to a severe shortness of breath along with chronic weakness. He
stated that he was feeling light headed and checked his vitals which showed an abnormal heart rate
with low blood pressure and oxygen saturation. This led him to go to the emergency department. He
stated that he lives in an assisted living center and has difficulty walking and moving around so he
usually does not move a lot during the day. His past medical history was notable for atrial fibrillation.
Review of symptoms was positive for pulmonary system concerning patient's shortness of breath. The
patient denied fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, urinary systems, or
head ache. The patient had no allergies and his tetanus status was up to date.
Patient's vital signs were as follows: blood pressure 201/74 mmHg; pulse 69/min; SpO2 94%;
temperature 98.4 oF. On physical exam, he was alert and oriented to person, time, and place and in no
acute distress. However, during pulmonary exam rales were heard in the lungs.
Laboratory analysis revealed a normal white blood cell count and CBC was within normal limits. The
initial troponin tests were negative. Urinalysis showed no alarming abnormalities.
AP radiograph of the chest shows that the heart and pulmonary veins are dilated. There is a blurred and
indistinct pulmonary vasculature which indicates interstitial pulmonary edema (Figure 1).
Joseph Carter
Abstract
The case being presented is one of congestive heart failure that was diagnosed in the emergency
department. The clinical history and diagnostic findings are discussed.
1. Introduction
Congestive heart failure is a severe cardiovascular disease that when left untreated can increase the
chances of death. It is very common in the United States and affects millions of people, especially those
over the age of 65 [1]. Emergency physicians should maintain suspicion of congestive heart failure
when patients show symptoms of pneumonia.
Risk factors for developing CHF are age, obesity, history of heart attacks, and congenital heart defects;
the main risk is age and it increases as people get older and the heart muscles weaken [2].
2. Case Presentation
An 88-year-old male presented due to a severe shortness of breath along with chronic weakness. He
stated that he was feeling light headed and checked his vitals which showed an abnormal heart rate
with low blood pressure and oxygen saturation. This led him to go to the emergency department. He
stated that he lives in an assisted living center and has difficulty walking and moving around so he
usually does not move a lot during the day. His past medical history was notable for atrial fibrillation.
Review of symptoms was positive for pulmonary system concerning patient's shortness of breath. The
patient denied fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, urinary systems, or
head ache. The patient had no allergies and his tetanus status was up to date.
Patient's vital signs were as follows: blood pressure 201/74 mmHg; pulse 69/min; SpO2 94%;
temperature 98.4 oF. On physical exam, he was alert and oriented to person, time, and place and in no
acute distress. However, during pulmonary exam rales were heard in the lungs.
Laboratory analysis revealed a normal white blood cell count and CBC was within normal limits. The
initial troponin tests were negative. Urinalysis showed no alarming abnormalities.
AP radiograph of the chest shows that the heart and pulmonary veins are dilated. There is a blurred and
indistinct pulmonary vasculature which indicates interstitial pulmonary edema (Figure 1).
