Congestive Cardiac Failure

Mr Ward is a 71 year old male who reports feeling a non-radiating, -heavy- discomfort in the lower retrosternal and epigastric region particularly when he bends over or walks short distances. He also reports a further 7 days of dyspnoea during moderate exertion. On examination his blood pressure was 165/95 mm HG, pulse 90 -100 bpm, respiratory rate of 24 with inspiratory crackles at both lung bases.
The following blood tests where ordered: a full blood count (FBC), Urea Electrolytes and Creatinine (UEC), Liver Function Tests (LFT), CK and Troponin. All results were within normal limits.
An Arterial Blood Gas was also collected resulting in: pH 7.410, pCO2 38.7mmHg, PO2 69.8mmHg, HCO3 24.0mmol/L, BE -0.7mmol/L and O2 SAT 89.3%
Mr Ward also has an ECG that showed normal sinus rhythm, and a chest x-ray showing cardiac enlargement and lower-lobe infiltrates, suggesting the presence of acute exacerbation of congestive cardiac failure.

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