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
Author: jason.lopez

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.


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
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