Mr. J.D., a 68-year-old male with a history of chronic heart failure (CHF) secondary to ischemic cardiomyopathy, presents

Mr. J.D., a 68-year-old male with a history of chronic heart failure (CHF) secondary to ischemic cardiomyopathy, presents to the emergency department (ED) with worsening dyspnea, orthopnea, and bilateral lower extremity edema. He reports a recent Thanksgiving celebration where he indulged in high-sodium foods, including ham, mashed potatoes with gravy, and canned vegetables. His symptoms began escalating shortly after the holiday meal, with progressive difficulty breathing and increased fatigue. Clinical Assessment: Upon admission, Mr. J.D.’s vital signs reveal tachypnea (respiratory rate 24 breaths/minute), tachycardia (heart rate 110 bpm), elevated blood pressure (160/90 mmHg), and oxygen saturation of 88% on room air. Physical examination demonstrates jugular venous distention, bibasilar crackles on lung auscultation, and pitting edema extending to mid-shins bilaterally. Laboratory investigations reveal elevated B-type natriuretic peptide (BNP) levels.

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