New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea.BP:143/99, Pulse 109, Temp 37.2 °C (99 °F), Resp (!) 32, SpO2 95%On exam, he was tachypneic and had bibasilar crackles.Here was his ED ECG:There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities.There is a large peaked P-wave in lead II (right atrial enlargement)There is left axis deviation consistent with left anterior fascicular block.There are nonspecific ST-T abnormalities.There is no evidence of infarction or ischemia.Troponin I was 0.054 ng/mLNT-ProBNP was 8316 (0-900 pg/mL)."NT-proBNP values less than 300 pg/ml have a 99% negative predictive value for excluding congestive heart failure. A cutoff of 1200 pg/ml for patients with a normal eGFR is very specific for heart failure. A diagnostic NT-proBNP cutoff of 900 pg/mL has been suggested in adults 50-75 years of age in absence of renal failure. "A bedside POC cardiac ultrasound was done:Findings: Decreased left ventricular systolic function.The patient was given furosemide and admitted to the hospital.Later, he underwent a formal echocardiogram:Very severe left ventricular enlargement (LVED diameter 7.4 cm).Severely decreased left ventricular systolic function with an estimated EF of 20-25%.No left ventricular wall motion abnormality identified.Severe right ventricular enlargement and mildly d...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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Conclusion: Ambulatory renal and cardio-vascular follow-up in case of neonatal medical history can be enhanced, with necessity to raise awareness and to edict guidelines available to pediatricians.What is Known:•There is a compelling evidence of long-term renal and cardiovascular consequences of prematurity and low birth weight.•Specific cardiovascular and renal follow-up guidelines, coming from professional organizations, are currently not available for these patients.What is New:•Pediatricians in ambulatory setting do not adapt their renal and cardiovascular follow-up in case of neonatal medical history.&b...
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