Ms. W has a 30-year history of hypertension and hyperlipidemia and an 8-year history of systolic dysfunction. She has persistent atrial fibrillation (AF) and an AICD for primary prevention. She was hospitalized for congestion following a 5-day river cruise. She seemed to have a good response to therapy with relief of her congestive symptoms; however, she reports persistent weakness and fatigue impacting her quality of life. She finds it taxing to do her errands and feels washed out by the middle of the afternoon. Her appetite is poor; she is eating smaller portions and has lost another 3 lbs. since the hospitalization. A recent colonoscopy was unrevealing. Last year her hemoglobin count was 11.4 g/dL and it is now 9.8. The echocardiogram prior to hospital discharge was notable for an ejection fraction (EF) of 24%.

Current medications Laboratory findings
  • Lisinopril 20mg/day
  • Carvedilol 25mg BID
  • Torsemide 20mg/day
  • Spironolactone 12.5mg/day
  • Warfarin 4mg/day
  • Lipitor 40mg/day
  • Omeprazole 20mg/day
  • Sodium 138mEq/L
  • Potassium 4.1mEq/L
  • BUN 21mg/dL
  • Creatinine 1.1mg/dL
  • Hemoglobin 9.8mg/dL
  • Ferritin 72ng/mL
  • Transferrin saturation 17%

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