Day 0 · 11:00
Arrival
Ten days of worsening breathlessness, now at rest. Three-pillow orthopnea, twice waking gasping. His ankles have swallowed his sock lines and his home scales read four kilograms above usual. He stopped his 'water tablet' three weeks ago because bathroom trips were ruining his bowls club afternoons, and started ibuprofen for a sore knee.
Vitals
HR112BP104/68RR26SpO289% (room air)T36.7
Examination
- JVP: Elevated to the earlobes at 45 degrees.
- Chest: Bibasal crackles to the mid-zones; no wheeze.
- Cardiac: Irregularly irregular, no new murmur appreciated.
- Peripheries: Pitting edema to the knees; cool feet, warm legs.
Before a single test returns, the exam has essentially made a diagnosis. Which?