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Case Study #2 Congestive Heart Failure HPI HJ. presemed to the ER late one evening complaining of a “racing heartbeat.” She is an over-weight. 69-year-old white female, who has been experiencing increasing shortness of breathduring the past two months and marked swelling of the ankles and feet during the past threeweeks. She feels very weak and tired most of the time and has recently been waking up in themiddle of the night with severe breathing problems. She has been sleeping with several pillowsto keep herself propped up. Five years ago, she suffered a transmural {i.e., through the entirethickness of the ventricular wall). anterior wall (i.e.. left ventricle) myocardial infarction. Shereceived two-vessel coronary artery bypass surgery 41/2 years ago for obstructions in the leftanterior descending and left circumflex coronary arteries. Her family history is positive foratherosclerosis as her father died from a heart attack and her mother had several CVAs. She hadbeen a three pack per day smoker for 30 years but quit smoking after her heart attack. She usesalcohol infrequently. She has a nine-year history of hypercholesterolemia. She is allergic to nuts,shellfish. strawberries. and hydralazine. Her medical history also includes diagnoses ofosteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, anddaily aspirin and clopidogrel. The patient is admit- ted to the hospital for a thorough examination.