History of Present Illness
H.J. presented to the ER late one evening complaining of a “racing heartbeat.” She is an overweight, 69-year-old white female, who has been experiencing increasing shortness of breath
during the past two months and marked swelling of the ankles and feet during the past three
weeks. She feels very weak and tired most of the time and has recently been waking up in
the middle of the night with severe breathing problems. She has been sleeping with several
pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through
the entire thickness of the ventricular wall), anterior wall (i.e., left ventricle) myocardial
infarction. She received two-vessel coronary artery bypass surgery 41
⁄2 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history
is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three pack per day smoker for 30 years but quit smoking after her
heart attack. She uses alcohol infrequently. She has a nine-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical
history also includes diagnoses of osteoarthritis and gout. Her current medications include
celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel. The patient is admitted to the hospital for a thorough examination.
Patient Case Question 1. Based on the limited amount of information given above, do
you suspect that this patient has developed left-sided CHF, right-sided CHF, or total CHF?
Patient Case Question 2. How did you arrive at your answer to Question 1?
Patient Case Question 3. What is a likely cause for this patient’s heart failure?
Patient Case Question 4. From the information given above, identify three risk factors
that probably contributed to the patient’s heart attack five years ago.
Patient Case Question 5. Why is this patient taking allopurinol?
Patient Case Question 6. Why is this patient taking atorvastatin?
Patient Case Question 7. Why is this patient taking celecoxib?
Patient Case Question 8. Why is this patient taking aspirin and clopidogrel?
