D: How can I help you?

P: I've had, uh, worsening, uhm, shortness of breath, uhm, for the past couple of days.

D: OK, and, this has just been getting worse over the last couple of days?

P: Yeah.

D: OK, how far are you able to walk before getting shorter breath?

P: A couple of stairs, two to three stairs.

D: OK, and how far were you able, to, to walk before that?

P: Hmm, I'd say about ten or eleven stairs.

D: OK, and have you had shortness of breath like this before?

P: Yeah, uhm, six months ago.

D: OK, could you tell me about what happened six months ago? 

P: Yeah, yeah, I was feeling all, I was feeling, just like this was feeling awful. I went to the hospital. They started me on a water pill, kept me for a couple of days and then sent me back home. Uhm, they changed some of my meds, I think, increased the dose of something and yeah that's what happened. 

D: OK, I see and have you been having, uhm, any swelling?

P: Yeah, Oh my goodness, it's so bad I couldn't wear my shoes this morning. It's gotten worse over the past, one month.

D: Have you, have you had any changes to your weight?

P: Yep, gained five pounds in the past two months.

D: And have you had any changes to your appetite or, or diet or exercise?

P: I can barely exercise. I feel so short of breath. My dad's the same.

D: OK, uhm, and have you had any, uh, instances where you've woke up in the middle of the night extremely short of breath?

P: Yeah, that happened last night, couldn't fall asleep.

D: Did it help, uh, sitting up?

P: Yeah, I just went and sat on my chair and slept on the chair.

D: OK, and do you, uh, typically have problems with shortness of breath if you lie flat?

P: I do, I have to, uh, started using two pillows.

D: Is this a nightly thing?

P: It's, it's fine with the two pillows now.

D: OK. Yeah, and have you been experiencing any cough? 

P: No. 

D: Alright, and, uhm, how about any, any chest pain? 

P: No.

D: Have you been having any, uh, instances feeling as though your heart's racing or beating out of your chest?

P: No. 

D: Alright, have you had any fainting or dizziness? 

P: Uh, no.

D: Alright, have you had any wheezing? 

P: No.

D: OK, have you had any infectious symptoms such as uh, eye redness, eye discharge, nasal discharge or, or sore throat?

P: Not recently, I had that about two months ago, but that got better.

D: OK, did you need antibiotics two months ago?

P: No, no, just lasted a couple days and got better on its own. 

D: I see OK and, uhm, have you been having any abdominal pain? 

P: No.

D: How about any changes to bowel habits such as diarrhea or Constipation?

P: Uhm, no. 

D: Any urinary problems?

P: I do, I, I uhm, I leak urine sometimes, actually quite often.

D: OK, and do you use any medications?

P: No I, I, well I do, I use a lot of medications, uhm, but I  don't remember their names. Uh, I have this blister pack and I just take everything in it. Uhm, I also I brought the list of prescriptions, I can give that to you.

D: For sure, yeah I could go through, go through that, uhm here, uhm so, but first, have you been diagnosed with any medical conditions in the past?

P: Yeah, I have uh, heart, heart failure and uh, had two heart attacks and have high cholesterol, high blood pressure and, uh, I'm also overweight.

D: OK, do you know what your BMI is currently?

P: What's that? 

D: So this is a measure of body mass index and, uhm, can help give an indication about weight ranges, uhm, whether, uhm, being in a healthy weight range or, uhm, a weight range that's associated with, uhm, risk of certain diseases such as high blood pressure.

P: No, I, I, I don't know. I, I've never heard of that. I, I know my weight, I could tell you that.

D: Sure yeah.

P: I'm 250 pounds.

D: OK, and yeah we can check that, uh, with your height today.

P: My height is 5'2".

D: OK, thank you. And, uhm, so just looking at the medications here now, I see a variety for uhm, cardiovascular protection, so things like aspirin, beta blocker, ACE inhibitor, statin, uhm and, uhm, do you have any allergies to medications? 

P: No.

D: Uhm, and have you had any, uh, so you mentioned surgeries to your, to your heart? Do you have a stent placed?

P: Yeah, I had to stent put in after the first heart attack about five years ago and then another one, uh, three years ago.

D: OK, and have you, have you been stable in regards to your, uh, like chest pain? Have you had any?

P: No, I haven't had chest pain. I have a, uhm, a heart doctor who, uhm, I went to see after the last hospitalization six months ago. Things were looking OK at the time. He ordered a bunch of tests. I Haven't done all of them yet.

D: OK, do you know, uh, by any chance, what the, uh, last ejection fraction was on your echocardiogram?

P: I don't know, I, I don't know all of that. I don't know, you have to ask my daughter, she knows much more about me.

D: Yeah, no problem, well, we could look into, uh, some of those old, uh, older tests that you've done. OK, and, uhm, so can you tell me a little bit about your living situation currently? You mentioned your, your daughter, are you living with your daughter?

P: Yeah, I live with my daughter. My husband passed away, uh, three years ago, and so I've just been staying with my daughter. It's just the two of us now.

D: I see, I'm sorry to hear that about your husband. Uhm, are you currently, uh, like functioning independently around the home, or does your daughter help with a lot of the tasks?

P: Oh, she, she, she has to help me out, uhm she has to help me out. I uhm, I sometimes need help with the showering, simply because I get really short of breath and then, so I have to stop and it's just, she's just worried that it's unsafe, so she helps me out with that. Uhm, she gets most of the things done at home. She does the groceries and everything.

D: OK, I see, and do you, do you smoke cigarettes? 

P: I, I don't.

D: And, do you drink alcohol?

P: Not anymore.

D: OK, do you smoke marijuana or use any cannabis products?

P: No, no, no, no, nothing like that.

D: Alright, then, uh, do you, uhm, use any other recreational drugs?

P: No, no I don't.

D: Alright, uhm, have you been around anybody who you think might have been sick?

P: No, I've just been staying at home. My daughter's been working from home too.

D: OK, so uh, you haven't had much contact with, uhm.

P: No.

D: With others recently? OK, have you, so you haven't traveled anywhere?

P: No.

D: Alright, uh, and uh, and in terms of family history, has anybody had any heart or lung conditions?

P: Oh yeah, everyone in my family has high blood pressure. My mom had a heart attack. My brother had a heart attack. My sister had a heart attack. Everyone, everyone has heart problems.

D: OK, certainly sounds like something, uh, common in the family. Has there been any other, uh, conditions that run in the family? 

P: No. 

D: Alright, uhm, I, I don't, I don't think I asked. Have you had any fevers or chills?

P: No.

D: OK and or, or any night sweats?

P: No

D: OK, and, uh, I might have asked, but just to, to be complete, did you have any nausea or vomiting?

P: No. 

D: OK, uhm, so were there any other symptoms or anything else that, that I may have forgot to ask about?

P: No, I don't think so. It's just the, the difficulties with breathing and the swelling.

D: Yeah, so the first thing, I'll speak to your daughter and we will, uhm, get a look at some of the old or some of the reports from, uhm, over the last several months from, and from the cardiologist you see. But it's, uh, and then, uh, also we'll get some blood work and a chest x-ray. But it is sounding like this could be a heart failure exacerbation. Which, so some of the shortness of breath, it could be coming from fluid, uhm, that has accumulated in your lungs and so, uh, we'll give you, oh, another type of water pill now, Furosemide, to try and help get rid of some of that fluid so it will help with the breathing. And in the meantime, we'll wait for the investigations to come back. 

P: Sure, Thank you.