Mr. John Doe, a 72-year-old male with a long-standing history of chronic heart failure attributed to ischemic heart disease, was brought to the emergency department by his family due to increasing episodes of shortness of breath, especially at night, and swelling in his legs over the past week. Mr. Doe has been managing his condition with a regimen of ACE inhibitors, beta-blockers, and loop diuretics. Despite his adherence to medication, he has experienced gradual weight gain and decreased urine output in the days leading up to his presentation. His medical history is also significant for type 2 diabetes mellitus, controlled with oral hypoglycemics, and hypertension. On physical examination, Mr. Doe appeared visibly distressed, with labored breathing at rest, using accessory muscles. His blood pressure was noted to be 160/90 mmHg, with a heart rate of 98 beats per minute, respiratory rate of 26 breaths per minute, and oxygen saturation of 89% on room air. Bilateral pitting edema was evident in his lower extremities, and auscultation of the lungs revealed bibasilar crackles. Initial laboratory tests were notable for elevated BNP levels, abnormal renal function tests indicating acute kidney injury, and an ECG showing signs of left ventricular hypertrophy. What are the key factors contributing to Mr. Doe's acute presentation? How should Mr. Doe's acute kidney injury be managed in the context of his chronic heart failure? What lifestyle modifications and follow-up care would you recommend for Mr. Doe to prevent future exacerbations of his chronic heart failure and acute kidney injury?

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6th Edition

ISBN:9781337660549

Author:GREEN

Publisher:GREEN

Chapter10: Cpt Anesthesia

Section: Chapter Questions

Problem 18MC

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Mr. John Doe, a 72-year-old male with a long-standing history of chronic heart failure attributed to ischemic heart disease, was brought to the emergency department by his family due to increasing episodes of shortness of breath, especially at night, and swelling in his legs over the past week. Mr. Doe has been managing his condition with a regimen of ACE inhibitors, beta-blockers, and loop diuretics. Despite his adherence to medication, he has experienced gradual weight gain and decreased urine output in the days leading up to his presentation. His medical history is also significant for type 2 diabetes mellitus, controlled with oral hypoglycemics, and hypertension. On physical examination, Mr. Doe appeared visibly distressed, with labored breathing at rest, using accessory muscles. His blood pressure was noted to be 160/90 mmHg, with a heart rate of 98 beats per minute, respiratory rate of 26 breaths per minute, and oxygen saturation of 89% on room air. Bilateral pitting edema was evident in his lower extremities, and auscultation of the lungs revealed bibasilar crackles. Initial laboratory tests were notable for elevated BNP levels, abnormal renal function tests indicating acute kidney injury, and an ECG showing signs of left ventricular hypertrophy.

What are the key factors contributing to Mr. Doe's acute presentation?
How should Mr. Doe's acute kidney injury be managed in the context of his chronic heart failure?
What lifestyle modifications and follow-up care would you recommend for Mr. Doe to prevent future exacerbations of his chronic heart failure and acute kidney injury?

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