What would you do first?
An 84-year-old man was admitted from the nephrology clinic with worsening renal dysfunction and progressive dyspnea. He had been recently started on diuretics for volume overload, with a presumptive diagnosis of HFpEF noted by a prior 2-dimensional echocardiogram. The patient had a remote history of coronary artery bypass graft surgery, but he denied recurrent chest pains.
Physical examination findings were significant for an elderly man who was in no apparent distress, with an initial blood pressure of 100/60 mm Hg, a heart rate of 80 beats/min, and signs of biventricular volume overload as evidenced by an elevated jugular venous pressure of approximately 18 cm, bibasilar crackles, and bilateral lower-extremity edema.