An 82-year-old female with multiple medical conditions was admitted with recent complaint of increased shortness of breath. She was reported with dyspnea with mild exertion and unable to walk more than 50 meters. She also complained about of 2 pillow orthopnea but denies paroxysmal nocturnal dyspnea, chest pain or chronic lower extremity edema.
Past Medical History Hypertension for 9 years, CAD with angioplasty and stent one year ago, Ischemic cardiomyopathy (30% left ventricular ejection fraction by echocardiogram), osteoarthritis in knee, hips and hands, DM type II for 5 years. Medications Fosinopril (40mg/daily), furosemide (40/ twice daily), metoprolol (50 mg/daily), Potassium chloride, spironolactone, acetaminophen, Pioglitazone ECG: Normal sinus rhythm with no acute changes CXR: No infiltrated, interstitial edema consistent with mild heart failure (CHF). What can be the…
