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Physical Examination
BP 108/52
P 140, irreg.
R 30 and labored
Temp 99°F
Ht: 5'8"
Wt: 210.
General: Breathless, moderately obese male in acute distress sitting upright complaining "I
am going to die. Please help me."
Neck: Distended neck veins with visible cannon waves, JVD to 12cm. Carotids without
bruits.
Chest: Scattered rhonchi throughout, rales bilateral one third lower bases. Cough is
productive and frothy.
Heart: Tachycardia and irreg. Grade 3/6 systolic murmur at LSB, S3 gallop noted.
Abd: Liver palpable three centimeters below right costal margin. HJR+. Non-tender to
palpation, +Bowel sounds 4 quadrants.
Extremities: 4+ pitting edema of lower extremities to the knees. Nail beds minimally
cyanotic, no clubbing. Pulses intact.
EKG: Left bundle branch block. Atrial fibrillation with ventricular rate of 140.
CXR: Cardiomegaly with diffuse pulmonary infiltrate consistent with pulmonary edema.