Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 173: A 48-Year-Old Woman with Heart Failure
Nov 20, 2025
Dive into the world of heart failure with a compelling case study of a 48-year-old woman battling dyspnea. The discussion explores the intricacies of scleroderma, hypertension, and vital exam findings like elevated JVP and crackles. Insightful lab results reveal renal concerns and echo challenges, leading to a deeper understanding of pulmonary hypertension. The hosts clarify heart failure classifications, including reduced and preserved ejection fractions, with a focus on the implications for patient care. It's a captivating journey through cardiovascular complexities!
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Scleroderma Patient Presents With Heart Failure Signs
- A 48-year-old woman with 15 years of mild scleroderma developed progressive dyspnea, orthopnea, and edema over months with recent rest dyspnea.
- Her exam showed elevated neck veins, bilateral crackles, an S4, and 2+ pitting edema consistent with heart failure signs.
Hemodynamics Localize Left-Sided Failure
- Cardiac cath showed elevated right atrial pressure (15), mean PA pressure (30), and PCWP (20) with a cardiac index of 2.8 and preserved EF of 60%.
- These hemodynamics localize elevated filling pressures to the left heart despite normal systolic function.
Use PCWP To Diagnose HFpEF
- When PCWP is elevated without mitral disease, conclude left atrial pressure is high and diagnose left ventricular failure.
- With preserved or high EF, label the syndrome heart failure with preserved ejection fraction (HFpEF).
