A 69-year-old man with a history of atrial fibrillation, chronic kidney disease, congestive cardiac failure, and Fragile X Syndrome presented to the Emergency Department with dyspnea following an unwitnessed fall. He was diagnosed with acute pulmonary edema and congestive heart failure, rapidly deteriorated, and was placed on BIPAP support. Despite treatment, his condition did not improve overnight. The following morning, his family and treating physicians made a joint decision to transition to comfort care, and he died shortly thereafter. Autopsy confirmed pericarditis as the cause of death. This case highlights the importance of comprehensive cardiac assessment in patients with known cardiac disease presenting with respiratory distress, and the challenge of managing complex cardiac conditions in elderly patients with multiple comorbidities.
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Specialties
emergency medicinecardiologygeneral medicine
Clinical conditions
pericarditisacute pulmonary edemacongestive heart failureatrial fibrillationchronic kidney diseaseFragile X Syndromedyspnea
Procedures
BIPAP (bilevel positive airway pressure) support
Contributing factors
Pre-existing atrial fibrillation
Chronic kidney disease
Congestive cardiac failure
Recent unwitnessed fall
Rapid respiratory deterioration
Health decline following previous hospital discharge
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