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 2024/10/05 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.