Episode 5 - Leg Swelling

Vitals & Useful Links:

• Learn about one important cause of lower extremity edema (see spoilers below if you want to know which one)
• Podcast: BNP for Diagnosis of Acute CHF - EM Cases Podcast, a great discussion of BNP in the diagnosis of CHF
• Clinical Reference: ACC Guidelines for Management of Heart Failure

Time to learn about some puffy legs!

This week Kyle (MS4) leads Arman (MS4) and Abby (MS4) through a case he had of a 56-year old male with a swollen legs. How would approach this case? As always, we learn a couple very important points about one etiology of lower extremity edema. You can check out a great discussion about the use of BNP in diagnosing CHF on the EM Cases Podcast, and here's a great reference for headaches from ACC's guidelines on CHF management. If you have any questions, concerns, or comments, please email us at [email protected]

*EPISODE SPOILERS BELOW*

Here's the article we presented today
Daniels, L. B., Clopton, P., Bhalla, V., Krishnaswamy, P., Nowak, R. M., McCord, J., ... & Abraham, W. T. (2006). How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure: results from the Breathing Not Properly Multinational Study. American heart journal, 151(5), 999-1005.

Here's the ACC's Guideline on CHF Management
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., ... & Hollenberg, S. M. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology, 70(6), 776-803.

How Salt Affects BNP Levels
Morten Damgaard, Jens Peter Goetze, Peter Norsk, Niels Gadsbøll, Altered sodium intake affects plasma concentrations of BNP but not proBNP in healthy individuals and patients with compensated heart failure, European Heart Journal, Volume 28, Issue 22, November 2007, Pages 2726–2731.

We briefly mentioned Lasix dosing in CKD, here's an article describing various dosage considerations
Oh, S. W., & Han, S. Y. (2015). Loop Diuretics in Clinical Practice. Electrolyte & blood pressure : E & BP, 13(1), 17–21.

DISCLAIMER:
The views/opinions expressed in this podcast are that of the hosts/guests and do not reflect their respective institutions. This is NOT a medical advice podcast, if you are having a medical emergency you should call 911 and get help. This is an educational podcast, and as such, sometimes we get things wrong - if you notice this, please email us at [email protected].