Assessment and treatment of acute heart failure—Case Study: Wet and warm profile with concomitant anuric renal failure

An 86-year-old man arrived by ambulance at the emergency department (ED) at 7:15 P.M. with shortness of breath, wheezing, and sweating. The history obtained of his present illness was brief due to the patient’s extreme dyspnea. He had missed his dialysis appointment the previous day, and he complained of worsening shortness of breath that morning. En route he received nebulized albuterol and was on 100% O2 by nonrebreather mask. The patient had suffered a myocardial infarction approximately 7 years previously. He had also undergone two cardiac catheterizations documenting extensive coronary artery disease (CAD), resulting in angioplasty with subsequent stent placement. In addition, he had a history of congestive heart failure (CHF) and hypertension that precipitated end-stage renal failure requiring hemodialysis. He also had chronic obstructive pulmonary disease (COPD) and was on home O2 at 2 l/min. His medications were as follows: enalapril 40 mg/day, clonidine 0.1 mg t.i.d., isosorbide dinatrate 25 mg/day, atenolol 25 mg/day, salmeterol 2 puffs b.i.d., fluticasone 2 puffs b.i.d., albuterol p.r.n., lansoprazole 15 mg/day, calcium acetate 665 mg t.i.d., and Nephrocaps 1/day.