Pete is a 56 year old gentleman with a history of non-ischemic dilated cardiomyopathy with a previous ejection fraction of 20%.

Pete is a 56 year old gentleman with a history of non-ischemic dilated cardiomyopathy with a previous ejection fraction of 20%. He was recently hospitalized for sustained ventricular tachycardia. In the past three weeks he has been experiencing worsening altered mental status and fluid overload. During the admission he was diuresed and due to worsening cardiac function, he underwent a right heart catheterization which showed severely reduced resting cardiac output with an index of 1.5 and a cardiac output of 3 based on Fick equation. The patient was placed on dobutamine to treat the poor cerebral perfusion with his low cardiac output state. He has concomitant nonobstructive coronary artery disease, paroxysmal atrial fibrillation (on anticoagulation), hypertension and hyperlipidemia, obesity, type 2 diabetes, chronic renal insufficiency and recent hospitalization for sustained ventricular tachycardia despite biventricular internal cardiac defibrillator. Medications include: Lasix 80 mg p.o qd, allopurinol 300 mg po. qd, warfarin 5 mg po qd, Lantus 50 units SQ bid with sliding scale insulin, metolazone 5 mg qod, Lunesta 2 mg at HS, venlafaxine 150 mg in AM and 75 mg in PM, aspirin 325 mg qd, atorvastatin 40 mg hs, KCL 20 mg qd, lisinopril 10 mg qd, colchicine 0.6 mg bid, deplin 7.5 mg qd, alprazolam 1 mg po hs prn for anxiety and albuterol prn.

The patient is being evaluated for a heart transplant. Palliative Care has been consulted to evaluate the appropriateness for transplantation.

Define the difference between dilated and ischemic cardiomyopathy
Describe left heart failure symptoms and contrast with right heart failure symptoms
Discuss the medical management in this case
Discuss the use of implantable cardiac defibrillators as has been the case with Pete
Matzo & Sherman – Chapters 13, 14
Ferrell & Coyle – Chapter 14, 28
Symptom Management Algorithms – p. 46-51, 64-69
Resources:
HPNA teaching sheets on Managing Dyspnea
HPNA Quick Info sheet on COPD
www.Pallimed.org
Fast Facts at www.eperc.mcw.edu/EPERC/FastFactsandConcepts
#027, #111, #112, #141, #143, #144, #205, #242

 
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