Heart Failure Read Online Free PDF

earlier by ambulance. Heart problems. The ER doc wants to know if you’d like to see him.”
    Lila, now quite professional, said, “I’ll let patients know you’ve had an emergency. They can wait or we’ll reschedule. Go ahead.”
    Carrie walked through the breezeway that connected the clinic with the hospital, then made her way to the ER. Thecharge nurse handed her a chart and pointed to a curtained cubicle.
    Carrie flipped through the pages, noting the history of weakness, blurred vision, and a sense of palpitations, culminating in a fainting spell. The ER doctor had already ordered blood work, and the report was on the chart. Carrie scanned the figures, stopping when her eyes lit on the potassium level: 2.6 mEq/ml—definitely a contributory factor, and something that should be corrected as quickly as possible.
    She pulled aside the curtains and took in the scene. “Mr. Berringer, what’s going on?”
    The older man, pale and sweating, turned his head slightly toward her. The oxygen mask on his face added a hollow timbre to his voice. “I wish I knew, Doctor.” He opened his lips to say more, but instead closed his eyes, apparently spent by the effort.
    Carrie turned to Berringer’s wife, who stood beside the gurney, alternately blotting beads of perspiration from her husband’s forehead and stroking his hand. “Mrs. Berringer, is your husband taking any medications other than the ones you told the emergency room doctor about?”
    “Dr. Markham, they’re all medicines you prescribed. Don’t you have the list there?”
    Carrie smiled at her and said gently, “Let’s pretend I don’t.”
    The woman frowned. “You know about the heart pills and the cholesterol medicine. And, of course, there are those little tiny pink pills, but I don’t think they count. They’re just water pills of some kind.”
    Carrie tried not to grind her teeth. “Do those little pink pills have a long name that’s shortened to some letters?”
    “Oh, yes.” The woman’s face brightened. “I remember. HCZT or HTCZ or something like that.”
    Hydrochlorothiazide, or HCTZ, was a diuretic given to patients with high blood pressure, but it also could deplete potassium levels in the body. And when this occurred in patients who’d taken an overdose of digitalis, the combination had the potential to be lethal.
    Soon Carrie was able to put together the story. Henry Berringer refused to be “one of those people who use little pillboxes” to tell him if he’d taken his medicine on that particular day, choosing instead to rely on his memory. Apparently, for the past several days he’d taken his pills two or three times a day. The resulting digitalis overdose at first manifested itself as nausea and lack of appetite. He complained of seeing a yellow halo around lights, something he blamed on his early cataracts. But when he fainted in the living room, his wife called 911. His pulse was fifty and irregular when the paramedics arrived.
    “You’ve taken too much of some of your medicine,” Carrie said to Mr. Berringer. “We need to make sure that doesn’t happen again. In the meantime we’re going to do some things to reverse the effects of that overdose.”
    Mrs. Berringer looked so relieved that Carrie thought she might burst into tears. “Thank you, Doctor,” she mouthed as Carried slipped through the curtains with a promise to be back as soon as she could.
    Carrie spent the next several hours shuttling between the clinic and the ER. Finally, thanks to atropine, Digibind, and intravenous potassium, Mr. Berringer’s heart rate and rhythm were approaching normal levels. Carrie thought it would bebest to watch him for a bit longer, and since he had a disturbance of cardiac rhythm and might have sustained heart muscle damage, there was no problem getting approval for his admission to the hospital’s medicine floor. If serial EKGs and cardiac enzymes showed no further problems, she’d let him go home—but with a lecture about