I can't lie flat anymore

Updated: Jun 9

HISTORY


67 yo F presented to the hospital with fatigue and inability to lie flat.


She has a history of hypertension, diabetes type II (Last A1c was 8.3%), obesity, gout.


She was in her normal state of health until approximately 1 month ago when she noticed some shortness of breath in the evenings when she would lie down. Was mild initially, but slowly progressed to the point where she was sleeping in her recliner. During the day she hasn't been too short of breath, however her activity level is limited.


She also noted her shoes and socks have been tighter than before. Denies chest pain, fevers, chills, nausea, vomiting or diarrhea. Unsure if she has gained weight, as she does not weigh herself.


PHYSICAL EXAM


T 98.3 HR 93 BP 113/76 RR 20 SpO2 93% on 2L


No acute distress

No lymphadenopathy, unable to assess JVD due to neck size

Tachycardic, no murmurs

Lung sounds distant

Abdomen soft

1+ pitting edema bilaterally


POCUS EXAM


Right anterior




















Right lower




















Left Anterior

CARDIAC


Parasternal long


Unable to acquire good window in other cardiac views due to body habitus


What is the likely diagnosis?


Click here for answer & learning objectives

POCUS Med Ed

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