Cardiology eConsult
CHF with Afib
SPECIALTY
Cardiology
CHIEF COMPLAINT
CHF with Afib
COMMENTS TO SPECIALIST
This is a 67-year-old female with morbid obesity, seizure, chronic systolic heart failure, and chronic stage II kidney disease. Recently, in the hospital with urosepsis, pneumonia, and acute, chronic heart failure with brain natriuretic peptide (pro-BNP) of 26,800. Elevated troponins due to type II myocardial infarction.
She was ultimately started on furosemide 40 mg a day, carvedilol 6.25 mg twice a day, and spironolactone 25 mg a day. During her hospital stay, she had episodes where she was on pressure support as well as Diamox for metabolic acidosis. While there, she had an echocardiogram that showed a left ventricular ejection fraction of 30% to 35%. The patient remains a full code.
Cardiology considered Entresto but wanted to wait until her blood pressure and sepsis improved. Her blood pressure is now 120 systolic.
MAIN QUESTION
Is it safe to start Entresto?
Measuring Practice Success and Patient Care: Identifying Conditions
Easily Managed in the Primary Care Setting
Eric Urquiza, Sr. Vice President of Operations & Client Experience at AristaMD
If it’s not urgent, procedural or diagnostic, it likely can be managed in the primary care setting using an eConsult.
eConsult specialists also support patients with chronic conditions and abnormal labs and imaging.
Finally, patients with comorbidities are often good candidates for eConsults.
To diagnose and treat the patient referenced on the right side of the screen, a PCP would need to consider referring her to as many as 3 specialties – Cardiology, Endocrinology and Psychiatry.
Given the patient’s symptoms, the time required to obtain multiple appointments, and the costs of accessing specialty care, a better approach would be to start with an eConsult. In this case, the PCP decided to request a Cardiology eConsult, which identified the recent addition of Atenolol as the source of her symptoms.