Outpatient B: Early Diagnosis of HF

Patient:	44 y/o obese female; long-standing history of hypertension (11 years). Chief complaint of fatigue and shortness of breath.
History:	Patient was diagnosed with type II diabetes three years ago. Currently treated with lisinopril for hypertension and metformin for diabetes. Fatigue and shortness of breath occurred while performing routine daily activities such as housecleaning. No chest pain or pressure during activities.

Physical Examination

VS:	Temp 98.7, HR 80, BP 145/85
Neck:	Unable to appreciate whether jugular venous distention is present because of patient’s obesity.
CV:	Regular rate & rhythm, no murmurs, rubs or gallops.
Lungs:	Poor auscultation secondary to body habitus but no crackles or wheezes appreciated
Ext:	Warm, dry, 2+ pulses, 1+ pitting edema of feet.

Disposition: Patient with multiple risk factors for cardiovascular disease including potential heart failure. Exam equivocal secondary to patient’s large body size. Counseled patient on importance of weight loss. Continued aggressive blood pressure glucose management. Ordered BNP test. BNP level was 143 pg/ml- which, when evaluated with other clinical information available to the physician, illustrates that the patient may have potential early LV dysfunction. Physician will refer patient for chest x-ray and echocardiogram.