Emergency Department Minute Quiz: Chest Pain in CAPD Patient

September 22, 2020

Our latest Emergency Department Minute Quiz from Brady Pregerson, MD. Can you determine the correct diagnosis?

History: A man in his 70’s w/ ESRD on peritoneal dialysis, type 2 diabetes, and diastolic heart failure presented to the emergency department for a 2-day history of dyspnea worse than his baseline dyspnea that started yesterday around 4 pm. He takes torsemide for CHF and denies any missed doses. His baseline is dyspnea after walking for 5 minutes, but today and yesterday he felt dyspneic walking between rooms at home. He endorses some mild abdominal distension, but denies any abdominal pain, fever, chills, new leg swelling, chest pain, or other complaints.

Exam:

  • Vital signs are normal except for a pulse ox of 92% on room air
  • LUNGS: labored respirations. Bibasilar rales. No wheezing.
  • HEART: Normal rate. Regular. Normal heart sounds.
  • ABDOMEN: Soft, non-tender. No guarding. No rebound.
  • PD CATHETER LOOKS FINE
  • EXTREMITIES: BILATERAL SYMMETRIC edema.

An EKG is done

COMPUTER EKG READ:

  • NSR
  • RBBB
  • LAFB
  • T-wave abnormality, consider lateral ischemia

What is the most likely diagnosis?

  1. Tachydysrhythmia
  2. Electrolyte abnormality
  3. Pulmonary Embolism
  4. Acute Coronary Syndrome