An 83-year-old with known severe coronary artery disease, diffuse small vessel disease, and significant stenosis distal to a vein graft from previous CABG surgery was admitted when his physician referred him to the hospital after a routine office visit. His symptoms included 3+ pedal edema, jugular vein distention, and heart sound abnormalities. Significant laboratory data obtained on admission were as follows:
Blood Urea Nitrogen (6 - 24 mg/dL): 53
Creatinine (0.5 - 1.4 mg/dL): 2.2
Total protein (6.0 - 8.3 g/dL): 5.8
Albumin (3.5 - 5.3 g/dL): 3.2
Glucose (60 - 110 mg/dL): 312
Calcium (4.3 - 5.3 mmol/L): 4.1
Phosphorous (2.4 - 4.5 mg/dL): 2.4
Total CK (54 - 186 U/L): 134
CK-MB (0 - 5 ng/L): 4
% CK-MB (<6%): 3
Myoglobin (<70 ug/L): 62
Troponin T (0 - 0.1 ug/L): 0.2
Questions:
1. What do the symptoms of the patient suggest?
2. Based on the preceding laboratory data, what do you think is the diagnosis?
3. Based on the preceding laboratory data, what are the organ system abnormalities?
4. What are the indicators of these organ system abnormalities?
5. What specific laboratory test do you think might indicate congestive heart failure in this patient?
