Skill Checkup: A 71-Year-Old Man With History of Chronic Heart Failure Presents With Dyspnea, Rales, and Ankle Swelling

Marco Guazzi, MD, PhD


May 02, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 71-year-old man in Europe presents with dyspnea, rales, and ankle swelling that developed over the past week. His height is 1.75 m (5 ft 9 in) and weight is 74 kg (163 lb; body mass index of 24). He has a history of chronic heart failure, defined as New York Heart Association (NYHA) class II-III. He was previously hospitalized for pulmonary edema (PE). Left ventricular ejection fraction (LVEF) is 33% and estimated glomerular filtration rate is 21 mL/min/1.73 m2. The patient has bradycardia. Brain natriuretic peptide is 402 pg/mL; haemoglobin is 10.3 g/dL.


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