A
56-year-old-male is referred to you because of generalized
edema and increasing abdominal girth. Eight years
ago, the patient underwent 5-vessel coronary artery
bypass (CABS) surgery. Six years, he underwent radiation
therapy for lymphoma. Comormidities include Type II
diabetes mellitus, hyperlipidemia and tobacco abuse.
He has 2-pillow orthopnea and mild exertional dyspnea
but denies paroxysmal nocturnal dyspnea (PND) and
recurrance of angina.
Physical examination reveals marked anasarca.
BP is 100/60 mm Hg. Pulse is 80/min and regular. Neck
veins are distended to the angle of the jaw in the
sitting position. There are no murmurs but an extra
sound is noted in early to mid-diastole. Breath sounds
are diminished at the bases.Tyhere are no rales. Abdominal
girth is increased and there is a fluid thrill with
shifting dullness. There is scrotal edema and 3+ pitting
edema of the legs.
