One-liner
72F with ischemic cardiomyopathy/HFrEF (EF 10–15%) s/p AICD, CAD s/p DES, CKD, prior LV thrombus/DVT on apixaban, prior CVA, and uterine cancer, admitted for acute decompensated HFrEF with volume overload and new O2 requirement.
Data snapshot
HR 110, SpO2 90% RA → 2L NC. Labs: NT-proBNP 21,633, Cr 1.90 (baseline 1.2–1.5), BUN 82, K 5.1, Na 134, troponin 253. CXR no acute abnormality.
Meds — reconciliation
DISCONTINUE Carvedilol 6.25 mg PO BID — therapeutic duplication with metoprolol succinate; dual beta-blockade increases bradycardia/hypotension risk.
Active problems
Acute decompensated heart failure with reduced ejection fraction (ischemic) | Acute hypoxic respiratory failure, POA
- Admit to telemetry
- IV furosemide 40 mg now, then 40 mg IV BID
- Strict I/Os; daily standing weights
- Wean O2 to maintain SpO2 ≥92%
- Hold ACEi/ARB/MRA given AKI and K 5.1
- BMP + Mg q12h while IV diuresing
Acute kidney injury on chronic kidney disease (suspected cardiorenal/prerenal) | Mild hyperkalemia, POA