2/11/2014, 3:30pm

Aleks Penev
CC: Mr. C is a 52 yo male who presented to clinic with shortness of breath starting 2
weeks ago.
HPI: Patient reported that his episode started suddenly as he was walking several
blocks down the street; he suddenly felt out of breath and needed to step aside to
catch his breath and stabilize himself. He noticed that he could not sleep on his
back after this event, requiring several pillows to prop himself up, as well as further
shortness of breath on exertion with no chest pain. After about a week, he visited
his physician in Chinatown who immediately suggested he go to the Bellevue ER. On
admission, he was found to have poor kidney function (creatinine 10) and was put
on dialysis. The patient stated at this point that he noticed bubbly urine for past 2
years. He was also found to have lower limb edema and a reduced ejection fraction.
In the week that followed, his volume problem has not resolved though it might
have improved slightly.
PMH: Patient reports being in general good health. He had a "serious lung infection"
and a tonsilectomy when he was a child and claims to have contracted Hepatitis B
by sharing food utensils with friends in 1987 though this seems unlikely. Patient
denies any recent infections, diabetes, hypertension, or previous episodes. Patient
stated no regular medications or allergies.
FH: Mother and sister diagnosed with breast cancer at 60 and 55 respectively.
Grandfather had diabetes.
SH: Works in a printshop in Chinatown for about 25 years doing digital design.
Denies regular drinking or recreational drug use. Patient was a pack/day smoker
since college, stopped when the episode occurred.
PE: Patient appeared well developed, well nourished, looked stated age and was in
no apparent distress. HR 98, RR 20. JVD visible with hepatojugular maneuver with
pressure about 10-11 cm. Observation revealed lower-limb pitting edema going up
the shins, hairless legs with mottled skin and multiple scars. PMI was palpable in
LLD in the 5th intercostal space. Pulses +2 in radial, carotid, dorsalis pedis; no
palpable post. tibialis pulse. Capillary refill was good in both limbs. Ascultation
revealed no rubs or thrills, a soft systolic murmur (1/6), S3 gallop and a loud P2.