68-year-old man with chronic HFrEF and hypertension, followed in a heart failure clinic.
Complaint: increasing ankle swelling and breathlessness walking to the bathroom over 4 days. History: missed several diuretic doses while travelling and ate restaurant food often; no chest pain or syncope. Exam: bilateral pitting edema, JVP higher than his previous visit, bibasal fine crackles, warm extremities, alert, making urine, weight +2.4 kg above baseline.
Vitals: T 36.8°C · HR 96 regular · BP 142/86 · RR 22 · SpO₂ 94% (room air)
Labs: Creatinine mildly above previous · K⁺ pending · ECG sinus rhythm · CXR mild pulmonary vascular congestion
What do you notice?
