Posters
Presenting Author Academic/Professional Position
Medical Student, MS2
Academic Level (Author 1)
Medical Student
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Heart failure is one of the most common reasons for hospital admissions among older adults. While healthcare providers often concentrate on medication adherence and complex triggers like ischemia or arrhythmia, this case emphasizes that dietary nonadherence—particularly excessive sodium and fluid intake—can be a significant yet overlooked factor contributing to decompensation.
Case Presentation: An 83-year-old Hispanic woman presented to the emergency department with shortness of breath, cough, and chest pain. Her symptoms and history were highly concerning. A non-ST elevation myocardial infarction (NSTEMI) just two months prior was attributed to vasospasm, likely triggered by her nicotine use. Her coronary angiogram during that hospitalization showed non-obstructing coronary artery disease. Nonetheless, the patient had only recently stopped smoking and was prescribed dual antiplatelet therapy but had been stopped due to a recent gastrointestinal bleed. She also has chronic obstructive pulmonary disease (COPD) but did not report an increase or change in her phlegm color or consistency. Notably, the patient also reported a new and progressive swelling in her lower extremities and had a history of heart failure with reduced ejection fraction of 35-40% from a recent echocardiogram. The patient’s family was very engaged in her everyday care and ensured that the patient was adherent to all medications, including her guideline-directed medical therapy (GDMT). The diagnosis was isolated as acute heart failure after review of laboratory, diagnostic, and clinical findings, but the cause was not quickly elucidated. Patient promptly improved with intravenous diuresis, continuation of GDMT, along with cardiac diet and fluid restriction. When more advanced queries yielded no rationale for the patient's exacerbation, it was the simple basics that explained it all. The patient was drinking over 2 liters of fluid a day and eating salt from her hands, along with extremely high sodium foods and condiments in excess. The patient and family were unaware of the implications of these habits, nor did they know about fluid restriction or how to adhere to a low-sodium diet, despite a diagnosis of heart failure for years.
Conclusion: This case reinforces the importance of patient and provider education in heart failure management. Despite GDMT adherence, the patient’s excess sodium and fluid intake caused acute exacerbation. Clinicians must not overlook basic lifestyle factors, as addressing them can prevent avoidable hospitalizations and improve outcomes in chronic heart failure.
Presentation Type
Poster
Recommended Citation
Fraga, Roberto J.; Mills-Reyes, Elizabeth; and Malaga, Nestor, "Back to the Basics: A Case of the Mundane and Overlooked Cause of Heart Failure Exacerbation" (2025). Research Colloquium. 87.
https://scholarworks.utrgv.edu/colloquium/2025/posters/87
Included in
Back to the Basics: A Case of the Mundane and Overlooked Cause of Heart Failure Exacerbation
Background: Heart failure is one of the most common reasons for hospital admissions among older adults. While healthcare providers often concentrate on medication adherence and complex triggers like ischemia or arrhythmia, this case emphasizes that dietary nonadherence—particularly excessive sodium and fluid intake—can be a significant yet overlooked factor contributing to decompensation.
Case Presentation: An 83-year-old Hispanic woman presented to the emergency department with shortness of breath, cough, and chest pain. Her symptoms and history were highly concerning. A non-ST elevation myocardial infarction (NSTEMI) just two months prior was attributed to vasospasm, likely triggered by her nicotine use. Her coronary angiogram during that hospitalization showed non-obstructing coronary artery disease. Nonetheless, the patient had only recently stopped smoking and was prescribed dual antiplatelet therapy but had been stopped due to a recent gastrointestinal bleed. She also has chronic obstructive pulmonary disease (COPD) but did not report an increase or change in her phlegm color or consistency. Notably, the patient also reported a new and progressive swelling in her lower extremities and had a history of heart failure with reduced ejection fraction of 35-40% from a recent echocardiogram. The patient’s family was very engaged in her everyday care and ensured that the patient was adherent to all medications, including her guideline-directed medical therapy (GDMT). The diagnosis was isolated as acute heart failure after review of laboratory, diagnostic, and clinical findings, but the cause was not quickly elucidated. Patient promptly improved with intravenous diuresis, continuation of GDMT, along with cardiac diet and fluid restriction. When more advanced queries yielded no rationale for the patient's exacerbation, it was the simple basics that explained it all. The patient was drinking over 2 liters of fluid a day and eating salt from her hands, along with extremely high sodium foods and condiments in excess. The patient and family were unaware of the implications of these habits, nor did they know about fluid restriction or how to adhere to a low-sodium diet, despite a diagnosis of heart failure for years.
Conclusion: This case reinforces the importance of patient and provider education in heart failure management. Despite GDMT adherence, the patient’s excess sodium and fluid intake caused acute exacerbation. Clinicians must not overlook basic lifestyle factors, as addressing them can prevent avoidable hospitalizations and improve outcomes in chronic heart failure.
