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Congestive Heart Failure

History of Present Illness

A 63-year-old male presents to the emergency room complaining of breathlessness for the past three days. Cardiac history is positive for a myocardial infarction three years ago followed by four-vessel coronary artery bypass surgery. The patient has been asymptomatic since surgery with no complaints of chest pain.

Over the last three months PTA, the patient notes onset of shortness of breath while unloading groceries, walking stairs, and other strenuous ADLs.

Two weeks ago, he was unable to complete his daily one-mile walk at the high school track. He noted swelling in his feet and ankles. Four days PTA he woke at 2 am short of breath and had to sleep in his recliner the rest of the night. He has been unable to lay flat in bed at night since then and has slept on 3 pillows. Yesterday, he became breathless walking from one room to another. He presents today with extreme shortness of breath. He denies chest pain.