Congestive Heart Failure

CONGESTIVE HEART FAILURE

A 55-year-old man with a dilated cardiomyopathy presents for open reduction and internal fixation of a tibial fracture following a motor vehicle accident. The patient has a past medical history of alcohol abuse, orthopnea, dyspnea on exertion, and several episodes of pulmonary edema. The patient’s medications include digoxin, furosemide, and captopril. Physical examination revealed bibasilar rales and an S₃ gallop. A gated blood pool scan showed a left ventricular ejection fraction of 15%. Cardiac catheterization indicated a left ventricular end-diastolic pressure of 25 mmHg, a cardiac index of 1.8 L/min/m², 2⁺ mitral regurgitation, and no coronary artery disease.