Acute C H F Exaserbation - What Is the Heart Responding To?

There is a clinical evolution, despite empiric treatment, for a c h f exasserbation. And it's worth reflecting on the fact that it can be very difficult to reframe a patient's chief concern and problem based on clinical evolution. It may be tempting to stick with the disnea pyramid when a more misty ch might be more appropriate. So our ob is to try to initiate a broad work up that targets metabolic causes of agitation and altered mental status which i bucket into electrolite abnormalities such as sodium calcium glucose. We have cause for concern for both potentially structural lesions but we don't hear of any dramatic event that would lead to a bleed. There are certainly infectious near