Patient presents for office visit follow-up following aortic valve replacement and development of complete heart block following surgery which lead to insertion of permanent pacemaker. Patient is three days post discharge returning to the office today complaining of shortness of breath. When asked, patient complains he has developed progressive orthopnea since his discharge three days ago. Upon further questioning patient reports having a cough when lying flat down in bed. Patient denies any chest pain, dizziness or fainting. Patient can only walk 30 feet and gets out of breath, patient was observed as being short of breath walking from the waiting room to the exam room approximately 25 feet. Also patient has also developed pedal edema and a 15-20 pound weight gain since his surgery.
Patient is observed walking, he is alert and oriented, mildly to moderately short of breath upon walking to the exam room from the waiting room. B/P is 132/73, 02 90% on RA, heart rate90 and regular. Patient’s weight today is 171; his pre-surgery weight per chart is 150, showing a weight gain of 21 pounds. INR was checked and resulted 5.1. Carotid pulses are 2+ and equal without bruits; neck veins are pulsatile and elevated at 45 degrees. Lungs sounds are diminished bilat in both bases. There is a loud three component pericardial friction rub heard, no gallops. 2+ edema is present in the lower extremities.
Patient has signs of heart failure following recent aortic valve replacement and pacemaker