RT Book, Section
A1 Titano, Ruwanthi
A1 Bietry, Raymond
A1 Pinney, Sean
A2 Lee, Kiwon
SR Print(0)
ID 1143956873
T1 Acute Decompensated Heart Failure
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143956873
RD 2024/04/25
AB A  70-year  old  man  with  past  medical  history  of  coronary  artery  disease  with  previous  percutaneous  coronary  intervention  (PCI),  systolic  heart  failure  (ejection  fraction,  40%),  poorly  controlled  type  II  diabetes  mellitus,  hypertension,  and  hyperlipidemia  is  admitted  to  the  neurosurgical  intensive  care  unit  after  resection  of  a  meningioma.  He  was  doing  well  postoperatively  until  overnight,  when  he  suddenly  developed  shortness  of  breath.The  patient  is  found  to  be  lethargic,  tachypneic,  tachycardic,  and  hypotensive  with  increased  work  of  breathing.  Cardiac  examination  reveals  sinus  tachycardia,  S3  gallop,  and  an  elevated  jugular  venous  pulsation  to  the  angle  of  the  jaw.  Bibasilar  crackles  are  heard  on  lung  auscultation.  His  lower  extremities  are  cold  and  clammy  with  minimal  pitting  edema.ECG  demonstrates  sinus  tachycardia  with  old  Q  waves  in  inferior  leads  and  new  ST  segment  depressions  in  leads  V4-V6.  Chest  radiograph  reveals  marked  pulmonary  vascular  congestion  bilaterally  with  cephalization.