In the ED, T 98.9 HR 88 RR 22 BP 130/90 98% RA. On examination, she is sitting up, appears tired, and is in no apparent distress. As you auscultate her heart, she asks whether you hear her murmur – “I’ve had a murmur my whole life” – you do not appreciate a murmur on examination. The rest of her cardiovascular exam is significant for 1+ pitting edema above her ankles, with normal arterial pulses throughout. She has a positive hepato-jugular reflux exam. Her lung exam is normal. ECG and chest radiograph are non-specific.
Which is the next BEST step in this patient’s management:
A. Draw thyroid function tests, and if normal, follow up with primary care
B. Start her on a daily diuretic medication such as hydrochlorothiazide and follow
up with primary care
C. Counsel her on weight management and screen for depression
D. Obtain a screening echocardiogram
In the meantime, a quote –
“Medicine is an art, and attends to the nature and constitution of the patient, and has principles of action and reason in each case.”
– Plato (429-327 B.C.)
…and…
“All things are hidden, obscure and debatable if the cause of the phenomena be unknown, but everything is clear if this cause be known.”
– Louis Pasteur (1822-1885)