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A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart rate, 112 bpm), tachypnea (24 breaths per minute), and hypoxemia (oxygen saturation, 94%, despite treatment with supplemental oxygen). The patient also had elevated jugular venous pressure, bilateral rales, and edema of the legs. The level of brain natriuretic peptide was elevated (780.8 pg per milliliter; normal level, <18.4). A chest radiograph showed an enlarged cardiac silhouette, a dilated azygos vein, and peribronchial cuffing, in addition to Kerley's A, B, and . . . [Full Text of this Article] |
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