Case Study

Heart Failure vs. Bacterial Pneumonia

Trevor Van Schooneveld, Internal Medicine, Infectious Disease 

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.


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.

Key takeaways

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. PCT gives insight into the presence or absence of systemic bacterial infection. In this case, PCT supported the absence of bacterial infection, and it was not necessary to start antibiotics. Clinicians were able to focus on treating the cardiac issues at hand.


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