74-year-old Medicare Beneficiary presented with altered mental status. Past Medical History is significant for CHF, s/p CABG and pacemaker and renal insufficiency.
2138: Pt presented to the ED: HR 143 and pedal edema on exam
2242: EKG with A. Fib RVR 131
2248: troponin #1 normal, troponin #2 elevated
0252: Inpatient order entered
0315: H&P – Pt with elevated troponin, CHF exacerbation and intermittent runs of A. fib with RVR which resolved with IV diltiazem. Mental status back to baseline. Plan for telemetry, IV Lasix, cardiology consultation and continue home meds.
0650: Cardiology consult: Acute on chronic diastolic heart failure exacerbation. Elevated troponin -nonspecific in etiology. Plan: Digoxin, check dig level, continue Lasix
0715: IM note: BNP improved with diuretics, no further intervention needed plan to discharge
1330: Discharge to home