Presumptive and differential diagnoses
The subjective findings provided in this case scenario are the increased shortness of breath the patient is feeling, the fact she has to sleep elevated on a pillow at night to sleep better, but denies chest pain, nausea or sweating. The objective findings include a blood pressure of 160/100, a pulse of 100, a respiratory rate of 16, and she is afebrile. On examination, there is distant air sounds, has late inspiratory crackles in both lower lobes, S1 and S2 sound distant, and an S3 can be heard on the apex of the heart.
The presumptive final diagnosis is congestive heart failure. This condition is described as “a complex clinical syndrome characterized by the reduced ability of the heart to pump and/or fill with blood” (Savarese & Lund, 2017). When a patient is diagnosed with heart failure, the cardiac output that is pumped is inadequate to meet the metabolic demands of the heart. Different classifications of heart failure exist and depends on the progress of the disease. Signs and symptoms associated with this condition include exertional dyspnea and/or dyspnea at rest, orthopnea, chest pain, pressure or palpitations, tachycardia, fatigue and weakness, rales, wheezing, S3 gallop, hepatojugular reflux and more (Dumitru, 2022).
A differential diagnosis to congestive heart failure is cardiogenic pulmonary edema. This condition is defined as pulmonary edema that is due to the increased capillary hydrostatic pressure, which is secondary to the elevated pulmonary venous pressure. It is more specifically defined as the accumulation of fluid due to the cardiac dysfunction. Patients with this condition have clinical features of left heart failure. Symptoms include extreme breathlessness, anxiety, with the feeling of drowning. Common presentation includes shortness of breath, as well as profuse diaphoresis, dyspnea on exertion, orthopnea, as well as paroxysmal nocturnal dyspnea. Additionally, cough is a common symptom which can represent worsening pulmonary edema. Pink and frothy sputum may also be seen with advanced disease (Sovari, 2020).
Another potential differential diagnosis for this patient is acute kidney injury, also known as acute renal failure. It is defined as an abrupt, or a rapidly declining of the renal filtration function. Typical lab values associated with his condition include a rise in serum creatinine concentration or by azotemia. Three categories of acute kidney injury exist, prerenal, intrinsic as well as postrenal. Multiple signs and symptoms are seen with this condition, which include skin problems, eyes and ears, cardiovascular system, abdominal as well as pulmonary problems. Cardiac issues include irregular rhythms, murmurs, pericardial friction rubs or increased jugulovenous distention, rales, and S3. Pulmonary wise, rales and hemoptysis may be observed as well (Workeneh, 2022).