Casus through there. Yvons of Cautenen and drain. Jerremy Wests
An 84-year-old man presents to the emergency department with general malaise for the past week. No chest pain, dyspnea, palpitations, or infectious complaints. The patient does have nagging pain in the left flank, radiating to the back, and suffers from polyuria. Because of these complaints and leukocytosis, the patient had received antibiotics from the GP four days ago, but without effect. The patient is familiar with atrial fibrillation, diabetes mellitus, peripheral vascular disease, hypercholesterolemia, obstructive sleep apnea, chronic renal function disorders, and early dementia. The patient uses rivaroxaban and gliclazide, among other things. The medication was taken faithfully.
On physical examination, the patient saturates 96% on room air with a calm respiratory rate and no abnormal lung sounds. Blood pressure is 133/89 mmHg, heart rate 67/min, there are no murmurs and no signs of congestion. The abdomen is supple and there is mild pain on the left flank. EMF is maximum, and temperature is 36.6 degrees Celsius.
Chest x-ray shows no infiltrate or overfilling. The lab shows, among other things, hemoglobin 7.8 mmol/L, leukocytes 8.4 *10^9/L, CRP 128 mg/L and creatinine 150 mmol/L (as previously stated), no abnormalities in platelets or liver enzymes, and the following ECG is shown.
Electrocardiogram
Echocardiogram
Focus echocardiogram in ED shows reduced left ventricular ejection fractions
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