This is a 70-year-old woman weighing 35 kg, followed in Primary Care and Cardiology Service of the Clínicaerta de Hierro in Madrid.
As a personal history, the patient had no toxic habits, was not hypertensive or had dyslipidemias.
The patient had heart failure secondary to multivalvular cardiomyopathy and had a double aortic and mitral Björk prosthesis with tricuspid annuloplasty since 1983, with NYHA functional class III-IV.
The patient had been implanted in an epiconic area due to VVI Medtronic disease since 1991.
As non-cardiological diseases he had a leucotrombal secondary to chronic HCV liver disease.
She was receiving digoxin, acenocoumarol and furosemide.
She came to the emergency room due to progressive increase in her habitual dyspnea until she became dehydrated, or 2 pillows and progressive increase in her lower limbs edema (high digestive insufficiency, 5 mg of folic acid and folic acid) in the upper limbs.
It is valued by us in home visits due to disorientation with disconnection of the environment the patient defined as “white mind”.
She also reported distress and malaise.
He had no headache, nausea, vomiting, muscle cramps or decreased reflexes.
There was no increase in habitual dyspnea, edema in the lower limbs or chest pain.
We performed an emergency laboratory test to determine a K: 5.2 mmol/l and a Na: 110 mmol/l with the rest of the parameters within normal limits, sending it to the emergency department for treatment of hyponatremia.
