Abstract
A 65-year-old male with history of coronary artery disease, anterior wall myocardial infarction 10 years ago, ischemic cardiomyopathy with left ventricular ejection fraction of 30%, presents to the emergency room with worsening dyspnea on exertion and orthopnea for 1 week. On examination, his heart rate is 88 beats/min (bpm) and regular, blood pressure is 126/74 mmHg, respiratory rate is 18/min with oxygen saturation measuring 94% at room air. The jugular venous pressure (JVP) is elevated to 14 cm of water. Examination of the lungs is notable for bibasilar rales. Cardiovascular exam reveals a laterally displaced apical impulse. The S1 is normal, S2 is physiologically split, and there is a moderately loud S3. There is no audible murmur. Abdominal examination reveals mild hepatomegaly, with the edge 2 cm below the costal margin, with no evidence of ascites. The lower extremities demonstrate moderate pitting edema to the mid-calf bilaterally.
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Goel, S.S., Stewart, W.J. (2013). Key Clinical Findings. In: Anwaruddin, S., Martin, J., Stephens, J., Askari, A. (eds) Cardiovascular Hemodynamics. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-195-0_5
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