Question

A 37 year-old female is seen in the clinic for follow-up of lower extremity swelling. HPI: Patient is here today for follow-up of bilateral lower extremity swelling. The swelling responded to hydrochlorothiazide. DATA REVIEW: I reviewed her lab and echocardiogram. The patient does have moderate pulmonary hypertension. Exam: Patient is in no acute distress. ASSESSMENT: 1. Bilateral lower extremity swelling. This has resolved with diuretics; it may be secondary to problem #2. 2. Pulmonary hypertension: Etiology is not clear at this time, will work up and possibly refer to a pulmonologist. PLAN: Will evaluate the pulmonary hypertension. Patient will be scheduled for a sleep study

Answer 1

Answer:

Evaluating her pulmonary hypertension and scheduling her for a sleep study was the correct procedure, however the clinic should test her for peripheral edema too.

Explanation:

If a patient has a cronic ilness as pulmonary hypertension, she must be tested for peripheral edema to avoid another complications such as pulmonary embolism. She arrived at the clinic showing lower extremity swelling.

Even though she had an echocardiogram, the physicians should dig a little deaper and investigate her heart condition as well.

Otherwise, she wil have a blockage of an artery in the lungs and have shortness of breath, chest pain, which leads to coughin up blood , fast heart rate and sudden death.

The simple fact that her swelling was solved by diuretics, do not mean she is out of danger.