Case No. 91

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Case No. 91

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Chief Complaint:

Heart transplant patient presents for follow-up

Published: Aug. 22, 2017
Case No. 91
Author: Jason2475
CASE SCENARIO

A 54year-old-male with a history on dilated cardiomyopathy and heart failure, now status post cardiac transplant 1 year ago, presents to the cardiologists office for a routine follow-up. The patient has been feeling well and has been compliant with all of his medications. You note that the patient is tachycardic to 110 in the office. He states he feels well and denies fevers. No coughing, chest discomfort, or shortness of breath reported. The remainder of his vital signs are normal. He is afebrile in the office. His cardiac exam is only notable for tachycardia. Mucous membranes are moist.

QUESTION

What is the next best step in management?

obtain blood cultures, chest X-ray, and basic laboratory studies
arrange for an outpatient echocardiogram
arrange for holter monitoring
arrange for admission to evaluate for transplant rejection
administer a bolus of intravenous fluids
discharge and arrange for a follow-up in several months