You
are in your office and it's time to see your next patient. She is
not on the schedule but called your office to be seen because she
feels horrible. She is a 73 year old female with history of CHF,
CAD, AFIB, HTN, CRI, DM and COPD. She wants to see you because she
has felt extremely nautious all day and vomited once already. She
said she just woke up feeling this way. She has no sick contacts,
no history of vertigo and felt fine last night and even got to play
poker with her friends. She has no abdominal pain or change in stool
habits. She has not tried any new foods and has not done anything
out of routine. The only thing she admits to is taking an extra
lasix last night because she wanted to fit into her nice shoes.
On review of systems she states that "My vision is a little
more blurry than usual when I woke up".
She has no drug
allergies, and is currently on Enalapril, Metoprolol, Lasix, Coumadin,Home
O2 PRN, Albuterol Nebs, Glucophage, NPH Insulin, MVI, Digoxin, Aspirin
and Colace. Her Vitals are BP 140/75, pulse 73, temp 97.0 and breathing
at 18. Physical exam is with in normal limits except for +S3, irregular
pulse, distant heart sounds, some crackles at the extreme bases
bilaterally, and no other findings with the abdomen totally benign.
You tell your nurse to come in and get an EKG and here it is below.
Does it help you at all to figure out what is wrong with her?
Click
Here for better quality EKG
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