The patient is a 61-year-old male with a past medical
history of hypertension and insulin-dependent diabetes
mellitus presented to the ED with new onset shortness
of breath. He reported a three week progression of
dyspnea after one flight of stairs, from a normal baseline.
The patient also noticed 2 pillow orthopnea and
increased urinary frequency and urgency. He denied
fevers, chills, chest pain, palpitations or productive
cough. Symptoms began when he ran out of his oral
medications three weeks prior to admission (furosemide,
enalapril, digoxin, metoprolol, spironolactone, aspirin).
Family history was positive for alcoholic cirrhosis. Social
history was positive for occasional tobacco and alcohol
usage. Review of systems was also significant for a 2 to 3
month history of abdominal fullness and q3 day bowel
movements. Upon further review, the patient stated he
had a distended abdomen earlier, as an adult, that had
somewhat disappeared until recently. He denied
decreased oral intake, nausea, emesis, reflux, abdominal
pain, diarrhea, melena or hematochezia.