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Management of a 72-Year-Old Woman with Heart Failure and Pulmonary Hypertension: A Case Study

This case involves a 72-year-old woman with a history of hypertension and diabetes, presenting with shortness of breath, cough, and significant lower limb edema. Diagnostic evaluations revealed left ventricular hypertrophy, mitral regurgitation, and pulmonary hypertension. Initial management included diuretics and antibiotics, with plans for transesophageal echocardiography and potential pulmonary hypertension treatment. The patient's symptoms improved with Bosentan, but she requires frequent readmissions for management. This case highlights the complexities of treating heart failure and pulmonary hypertension in older adults.

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Management of a 72-Year-Old Woman with Heart Failure and Pulmonary Hypertension: A Case Study

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  1. Sharqiyah Echo Club Anwar Jelani King Abdulaziz Hospital, Alhasa JelaniA@ngha.med.sa

  2. 72 year lady known case of HTN, DM came to ER. • S.O.B for 5 days.

  3. Cough and sputum • LL swelling worsening. • Chest tightness, sputum,

  4. Warfarin, • Furosemide, • Metoprolol, • Lisinopril

  5. O/E 104/59 • 110 bpm irregularly irregular • 82% on RA • 37.4 C.

  6. Elevated JVP • Resp Crept (loud) • Ascites and LL edema up to the knees

  7. Hb: 112 • WBC: 13 • Plt: 327 • BUN: 23 • Creat: 240 • BNP: 140 • Trop: 0.57

  8. Echo?

  9. What are your findings?

  10. LVH • Good LV systolic fx • MR ++ • LA enlargement

  11. TR +++ • RV dilated • RV volume overload • RV pressure overload

  12. What do you think is going on? • What would you like to know more? • How would that affect your management?

  13. Now, what is your working diagnosis at this moment? • How would you mange the patient at this time? • What will you plan?

  14. Admitted. • Lasix and Abx. • TEE

  15. ASD • TR • Pulm HTN (severe+)

  16. Dx? • Treatment? • Intervention? • Prognosis?

  17. Consulted pulmonary • IV diuresis. • INR • And discussed the further management.

  18. endothelin receptor antagonist. • competitive antagonist of endothelin-1, at ET-A and ET-B receptors. • Bosentin.

  19. Follow up in the OPD. • Symptoms improved in sense of NYHA. • Readmitted every few months when ran out of Bosentan.

  20. Thank you for your attention.

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