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

Based on the patient's history and presentation, the likely diagnosis is heart failure with reduced ejection fraction (HFrEF). A diagnosis of HFrEF requires the presence of symptoms or signs of HF and a reduced LVEF (≤ 40%), usually identified through echocardiography, which may reveal abnormalities such as Q wave or atrial fibrillation rhythm, LV hypertrophy, and a widened QRS complex.

The cardinal manifestations of HF are dyspnea, fatigue, and fluid retention. Although this patient has a history of HF and previous hospitalization for PE, the diagnosis should be differentiated from PE associated with injury to the alveolar-capillary membrane and PE caused by noncardiogenic PE and acute respiratory distress syndrome.

Basic workup approaches, including serum urea and electrolytes, creatinine, full blood count, and liver and thyroid function tests, are recommended by the European Society of Cardiology (ESC) to differentiate HF from other conditions, offer prognostic information, and inform treatment strategies. A chest radiograph is also recommended to explore alternative causes of breathlessness.


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