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A 69-year-old female, presents to the ED with pallor, dyspnea, and distended neck veins. She denies chest pain but admits to chest “pressure.” Her husband states she has been short of breath for 3 days, with increasing difficulty sleeping, resulting in her spending the previous night in a recliner chair. He also notes that swelling of her feet is worse this morning and that he could not put her slippers on. Mrs. Gilford reports her height is 5’1” and weight 162 lb. In the ED, her current weight is 175 lb, an increase of 13 lb above her stated weight. Mr. Gilford indicates his wife has not been following any specific dietary plan and does not monitor her blood pressure at home. She has a history of hypertension and coronary artery disease. Medications include Benicar HCT 40/35 daily, Toprol XL 100 mg/d, Lasix 40 mg/d, and potassium supplement, which her husband states she needs refilled and has not taken for a week. Vital signs are B/P 198/102; pulse 120, thready and slightly irregular; respirations 34; pulse oximetry 79% on room air. Auscultation of the lungs reveals crackles throughout both lower lobes, and a moist-sounding cough is nonproductive. Mrs. Gilford is placed on oxygen at 4 L/m by nasal canula. Following a chest x-ray, which shows pulmonary congestion and a moderately enlarged heart, Mrs. Gilford is admitted to the telemetry floor. You receive these STAT laboratory results— BNP level is 1046, and potassium is 2.8. An ECG report is pending.

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