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Case Study

Heart Failure vs. Bacterial Pneumonia

Trevor Van Schooneveld, MD, FACP
Internal Medicine, Infectious Disease

Case Overview
Age, sex 65-year-old female from long-term care facility
Chief complaint Increasing shortness of breath over the last day with minimally productive cough
Presenting symptoms Cough, cyanotic, no fevers/chills, oxygen saturation at facility in 80s
Significant medical history Recently discharged from hospital for acute myocardial infarction after stenting.

Clinical Timeline
Admission labs White blood count 12.6 x 10³/µL (87% neutrophils), lactate 2.9 mmol/L, mild acute kidney injury (AKI), PCT = < 0.05 μg/L
Differential diagnosis Community acquired pneumonia with sepsis vs. Atrial fibrillation (AFib) with rapid ventricular response and heart failure
Treatment, interventions Dose of antibiotics given in ED but not continued by hospitalist team. Diuretics provided and AFib rate controlled with beta-blocker. Significantly improved in the morning.

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Key Takeaways

Takeaway #1

This patient had a diagnosis of heart failure secondary to acute myocardial infarction (AMI) two days prior, but the clinical presentation offered multiple possibilities of differential diagnoses.

Takeaway #2

PCT gives insight into the presence or absence of systemic bacterial infection.

Takeaway #3

Clinicians were able to focus on treating the cardiac issues at hand.

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*NEWS or National Early Warning Score is a scoring system based on 6 common physiological measurements: respiration rate, oxygen saturation, temperature, blood pressure, heart rate and level of alertness. The score ranges from 0 to 20 points; a level of 5-6 means a patient can be very ill and requires regular monitoring and urgent review.

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Learn how antibiotic stewardship can help protect patients. Discover how to prevent the overuse of antibiotics to combat resistance.

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What is procalcitonin (PCT)? Procalcitonin is the most sensitive biomarker for bacterial specificity providing results to determine bacterial infection.

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The B·R·A·H·M·S Clinical Portal is your on-demand training platform for learning about procalcitonin (PCT) testing, from use in differential diagnosis and antibiotic treatment decisions to making bacterial co-infection assessments.

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Explore our learning center to find educational resources and FAQs on procalcitonin (PCT) testing, bacterial infections, antibiotic resistance, and more.

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Heart Failure vs. Bacterial Pneumonia

Learn more about implementing procalcitonin testing in your hospital.

Key Takeaways

Takeaway #1

Takeaway #2

Takeaway #3

Share your Clinical Experience

Related Resources

Learn more about implementing procalcitonin testing
in your hospital.