In a 72-year-old patient with congestive heart failure, ventricular dysfunction, ejection fraction less than 28%, and a BNP of 1089, what diagnosis should the CDI professional consider?

In a 72-year-old patient with congestive heart failure, ventricular dysfunction, ejection fraction less than 28%, and a BNP of 1089, what diagnosis should the CDI professional consider?

• A. Right-sided heart failure
• B. Acute and chronic systolic heart failure
• C. Diastolic heart failure
• D. Unspecified heart failure

Answer: (B)

The key idea is that a very low ejection fraction signals systolic, or pump, dysfunction. An ejection fraction under 28% means the left ventricle isn’t contracting effectively, which is the hallmark of systolic heart failure. The markedly elevated BNP (1089) further supports heart failure, since BNP rises in response to ventricular stretch and pressure overload. In heart failure, you can have a chronic baseline dysfunction with episodes of acute decompensation. Documenting it as acute and chronic systolic heart failure captures both the long‑standing reduced pump function and the current decompensation. Diastolic heart failure typically shows preserved ejection fraction, so the severely reduced EF makes diastolic failure less likely here. Right‑sided heart failure focuses on systemic venous congestion and can occur with left‑sided failure, but the data point strongest to a left‑sided systolic problem. Unspecified heart failure isn’t appropriate given clear objective findings. So the diagnosis to consider is acute and chronic systolic heart failure.

The key idea is that a very low ejection fraction signals systolic, or pump, dysfunction. An ejection fraction under 28% means the left ventricle isn’t contracting effectively, which is the hallmark of systolic heart failure. The markedly elevated BNP (1089) further supports heart failure, since BNP rises in response to ventricular stretch and pressure overload.

In heart failure, you can have a chronic baseline dysfunction with episodes of acute decompensation. Documenting it as acute and chronic systolic heart failure captures both the long‑standing reduced pump function and the current decompensation. Diastolic heart failure typically shows preserved ejection fraction, so the severely reduced EF makes diastolic failure less likely here. Right‑sided heart failure focuses on systemic venous congestion and can occur with left‑sided failure, but the data point strongest to a left‑sided systolic problem. Unspecified heart failure isn’t appropriate given clear objective findings.

So the diagnosis to consider is acute and chronic systolic heart failure.