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PATIENT PRESENTATION

Chief Complaint

“My ankles are swollen, and I can hardly do anything without getting short of breath.”

History of Present Illness

JW is a 51-year-old African American male presenting to the pharmacy-led heart failure clinic for 1-month follow-up of a heart failure with reduced ejection fraction (HFrEF) exacerbation that required hospitalization. It has been 6 months since his last office visit since he works as a truck driver and has been out of town. He asks for a prescription for compression socks as he has noticed increased swelling in his ankles.

Patient states he has been out of his furosemide and carvedilol for the past month. The carvedilol was added after his last hospital discharge. When asked about why he has not filled these, he states he does not like the side effects of the furosemide and often misses the second dose of carvedilol. He begrudgingly has a cell phone for his work but does not like to use technology. He states adherence to his other medications, though he sometimes makes it to the pharmacy a couple of days late due to his work. His primary care physician told him at discharge, “If you do not get it together and take your medications, you are going to die.”

Past Medical History

Hypertension (HTN)

HFrEF

Hyperlipidemia (HLD)

Myocardial infarction (MI) (status post CABG)

History of illicit drug use

Surgical History

CABG (3 years ago)

Family History

Mother: died age 60 from MI

Father: died age 51 from MI

Siblings: three brothers, one brother deceased from MI; three sisters, two of whom have had at least one MI before age 60

All siblings have HTN

Social History

Divorced and lives alone; monogamous female partner frequently visits.

Truck driver for the past 30 years (self-insured).

(+) Tobacco—1½ pack per day × 25 years.

(+) Alcohol—1 to 2 beers daily.

Immunization

Up to date

Insurance

Medicaid

Allergies

No known drug allergies

Home Medications

  • Aspirin 81 mg PO qd

  • Atorvastatin 80 mg one-half tablet PO qd

  • Furosemide 40 mg PO bid

  • Potassium 20 mEq PO qd

  • Lisinopril 20 mg PO qd

  • Carvedilol 12.5 mg PO bid

  • NTG 0.4 mg SL, PRN chest pain

  • Acetaminophen 500 mg PO, PRN back pain

Physical Examination

Vital Signs

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