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Congestive Heart Failure

Physical Examination

BP 108/52
P 140, irreg.
R 30 and labored
Temp 99°F
Ht: 5'8"
Wt: 210.

General: Breathless, moderately obese male in acute distress sitting upright complaining "I am going to die. Please help me."

HEENT: Normocephalic. Eyes, ears, and throat normal.

Neck: Distended neck veins with visible cannon waves, JVD to 12cm. Carotids without bruits.

Chest: Scattered rhonchi throughout, rales bilateral one third lower bases. Cough is productive and frothy.

Heart: Tachycardia and irreg. Grade 3/6 systolic murmur at LSB, S3 gallop noted.

Abd: Liver palpable three centimeters below right costal margin. HJR+. Non-tender to palpation, +Bowel sounds 4 quadrants.

Genitalia: Exam deferred.

Extremities: 4+ pitting edema of lower extremities to the knees. Nail beds minimally cyanotic, no clubbing. Pulses intact.

Neurologic: Anxious with feeling of impending doom. No localized or sensory deficits. Mental status intact.

Initial Laboratory Data

Na 130, K 3.8, HCO3 20. BUN 18. Cr 1.0.
ABG's on room air: pH 7.30, PaO2 55, PaCO2 28.

EKG: Left bundle branch block. Atrial fibrillation with ventricular rate of 140.

CXR: Cardiomegaly with diffuse pulmonary infiltrate consistent with pulmonary edema.