79 yo F with multifactorial chronic hypoxemia and dyspnea thought due to diastolic CHF, pulmonary hypertension thought secondary to a chronic ASD and COPD on 5L home oxygen admitted with complaints of worsening shortness of breath. Cardiology consult recommended a right heart cath for evaluation of response to sildenafil but the patient refused. Pulmonary consult recommended an empiric, compassionate sildenafil trial due to severe dyspneic symptomology preventing outpatient living, and the patient tolerated an inpatient trial without hypotension. Patient to f/u with pulmonology to start sildenifil chronically as outpatient as prior authorization is obtained.
Past Medical History:
- Atrial septal defect repair [**6-17**] complicated by sinus arrest with PPM placement.
- Diastolic CHF, estimated dry weight of 94kg
- Pulm HTN (RSVP 75 in [**11-24**]) thought secondary to longstanding ASD
- COPD on home O2 (5L NC) with baseline saturation high 80's to low 90's on this therapy.
- OSA, not CPAP compliant
- Mild mitral regurgitation
- Microcytic anemia
- Hypothyroidism
- S/p APPY, s/p CCY ('[**33**])
- Gallstone pancreatitis s/p ERCP, sphincterotomy
- Elevated alk phos secondary to amiodarone