Mr Wilson, a 70 year old man, presented to the emergency department (ED) accompanied by his neighbour at 10:15AM. He looked exhausted and found it hard to talk in long sentences due to difficulty in breathing, even at rest. Mr Wilson said that he caught a ‘flu’ about a week ago, and it was not getting any better despite his drinking plenty of water and taking paracetamol. He was also feeling very tired, and did not have the energy to prepare breakfast that morning. He stated that this might be because he has not been sleeping very well at night, as he has been needing extra pillows to sit up to help his breathing.
You noticed pitting oedema on his lower legs. Mr Wilson has had several heart attacks, with the last one occurring 18 months ago. Following this, he was diagnosed with congestive heart failure. He had an echocardiogram that showed he had a left ventricular ejection fraction (LVEF) of 30%. He also has a history of hypertension, osteoarthritis and cataract in the right eye. Mr Wilson lives by himself in a two-story unit. His wife, who was the primary carer for him, died 6 months ago. According to his neighbour, Mr Wilson has been withdrawn and depressed since his wife passed away. The neighbour helps Mr. Wilson as much as he can, as Mr Wilson does not have any other family.
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