Cardiology Case Report: Shortness of Breath Plus Erythrocytosis

History:

A woman in her early-50’s presents to the hospital with 3 days of body swelling and dyspnea. She is on Lasix but does not know why. She denies any chest pain, fever, cough or other complaints.

Exam:

Vital signs are normal except for a pulse ox of 84% on room are and a respiratory rate of 24. BP is 112/77. Physical exam is otherwise normal except for swelling of both legs up to the hips. There are no rales or wheezes but slightly asymmetric breath sounds

An ECG is done:

Computer Read: NSR at 86, marked RAD, low voltage, RBBB
Credit: Brady Pregerson, MD

Other Initial Diagnostic Testing:

• CBC: Hb =19.3, Plt = 127, WBC = 16
• Chem-7: normal
• Cardiac: BNP: 855, trop 23
• Imaging: CXR appears clear