Outpatient A: Potential Diagnosis of HF

Patient:	77 y/o male; chief complaint of SOB and concomitant chest pain
History:	Patient suffered myocardial infarction in 1977. Was diagnosed with COPD in 1999. Is currently treated with isosorbide and diltiazem and has been diagnosed with symptoms of GERD. Patient has a history of smoking and drinking.

Physical Examination

VS:	Temp 97.9, HR 94, , O2 Sat 98%, RR 18, BP 168/84
General:	Alert & Oriented
Chest:	Decreased breathing depth
CV:	Irregular heart rate and irregular heart rhythm; no murmurs gallops or rubs
Ext:	trace lower extremity edema

Disposition: Physician suspects HF – probability medium. Due to risk factors it is uncertain of differential diagnosis of HF, COPD, and PE. BNP test ordered. BNP level was 34 pg/mL, which, when evaluated with other clinical information available to the physician likely means the patient does not have HF. Physician pursuing another course of treatment.