A 72-year-old man with systolic heart failure (left ventricular ejection fraction, 20%) and hypertension was admitted to the hospital with 2 weeks of dyspnea at rest and a 20-lb weight gain. He reported good compliance with his outpatient regimen of lisinopril, carvedilol, spironolactone, and furosemide. Findings from physical examination were notable for a blood pressure of 95/40 mm Hg and heart rate of 105 beats/min, elevated jugular venous pressure, diffuse crackles in the lung fields, an S3 gallop, and warm extremities. The patient was admitted to the cardiac intensive care unit and administered intravenous furosemide, with a net diuresis of 2 L overnight.
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