Polymyalgia Pneumoni Case Study

This is a patient well known to me,over the last two decades, 85 years old, exceedingly healthy individual just had polymyalgia rheumatica, treated with low-dose steroids. No other significant disease states. She got a left lower lobe pneumonia in the early part of February, treated her with oral antibiotics including Levaquin, gradually got better but had a sudden worsening of her status and turned out to have atrial fibrillation. She was admitted to Duke Raleigh Hospital was found to have significant aortic stenosis with a calculated valve area of only a half a centimeter. She was not considered a candidate for TAVR intervention because of her pneumonia and a transient renal failure, and was discharged here to Mayview to clinically improve to a point that she could undergo cardiac intervention. Here there was no major improvement of her physical function or endurance. We did have serial laboratory data which showed an improvement of her creatinine from 3.5-1.5. X-ray showed that her pneumonia had cleared. I did talk to the TAVR team at Rex Hospital. Sent her over there
She was evaluated by Dr. Wu and Dr. Landvater, they did not think that given her overall condition that she would be a candidate for TAVR intervention as well. They were proposing a balloon valvuloplasty; however, Esther vetoed against any intervention, desired hospice intervention to return to Mayview for comfort measures only. When I saw her this afternoon she looked in her usual state resting in bed, awake and alert. Mentally oriented and appropriate. She has no overt heart failure. No neck vein distention. She has a high-pitched systolic murmur, but no peripheral edema. Her pulse ox is 92% on room air with a heart rate in the mid 80s. Hospice has seen the patient and admitted her to hospice services. She is on minimal medications now and there is no need for cardiac medications. I have assured the family that we will keep Esther comfortable both mentally and