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Washington University Experience | VASCULAR | Infarct - Remote | 9A0 Case 9 History
Case 9 History ---- The patient was a 64 year old man with a past medical history of stage IV chronic kidney disease, cardiomyopathy with congestive heart failure (EF=15%), type 2 diabetes mellitus status post bilateral toe amputation (micro and macrovascular complications), myocardial infarction (in 2010) status post coronary artery bypass graft surgery, hypertension, pacemaker placement in 2011, hyperlipidemia, sepsis secondary to decubitus ulcer, and old right parietal infarct due to a stroke in 1988 (25 years prior to his death) with residual left-sided weakness. The patient presented to the ED with complaints of shortness of breath and was admitted to the Intensive Care Unit for hypoxemic respiratory distress as well as hypotension and CHF exacerbation. He subsequently developed cardiogenic shock and lost a pulse, requiring CPR, intubation and was transferred the Cardiac Care Unit. The patient's mental status worsened due to hypoxic encephalopathy and end stage disease-related delirium. Due to patient's respiratory failure, acute and chronic kidney disease, coronary artery disease, altered mental status, and congestive heart failure the patient's grave prognosis was discussed with the family who decided to redirect to comfort care only.
