Question: Charles, Age 72, Has Reported To The Emergency Department Complaining Of Chest Pain. His Breathing Is Slightly Labored, With A Respiratory Rate Of 18 Breaths Per Minute. He Appears Pale And Anxious. Charles’s Heart Rate Is 86 Beats Per Minute, And His Blood Pressure, With Anti- Hypertensive Medications, Is 158/88 Mm Hg. Charles Complains That He Has …

Charles, age 72, has reported to the emergency department complaining of chest pain. His breathing is slightly labored, with a respiratory rate of 18 breaths per minute. He appears pale and anxious. Charles’s heart rate is 86 beats per minute, and his blood pressure, with anti- hypertensive medications, is 158/88 mm Hg. Charles complains that he has been having problems breathing, especially at night, and must sleep “propped up.” Auscultation reveals the presence of pulmonary crackles. ECG and echocardiogram results indicate left ventricular hypertrophy. Pulmonary capillary wedge pressure is elevated. In addition, jugular vein distention, peripheral edema, and enlargement of the liver are noted. 1. What are some reasons Charles’s heart rate is elevated? 1 2. What may account for Charles’s difficulty breathing, especially at night? 3. What is the significance of the left ventricular hypertrophy and the fact Charles is on anti- hypertensive medications? 4. What is the significance of the jugular vein distention, peripheral edema, and liver enlargement? 5. What do you expect to be the dingnosis for Charles?