How many pillows do you sleep on?

A 51 y/o African American female presented with shortness of breath. She had noticed that about 1 week ago it became difficult to do anything without becoming winded or worn out. She thought that maybe it was asthma or something. Tonight it had become worse and she was starting to have chest pain as well so her husband drove her to the hospital.

I entered her room and looked at her propped up on several pillows and struggling to get oxygen. She was an obese women who claimed to have no past illnesses. She was not taking any medications. Either she was very healthy or had not been to her doctor in a long time. I worried that she may be having a myocardial infarction and ordered an EKG.

I asked her if she found that she woke up in the night and felt like she could not breath. SHe said "How did you know?" She was waking up 2 - 4 times a night and would stand by the open window to catch her breath. I examined her legs and she had pitting edema. I asked her how many pillows she was sleeping on. She told me she sleeps on 4 pillows to prop herself up.

Her EKG came back unremarkable and her cardiac enzymes were negative which suggested that she was not having an MI. We ultimately determined that she had congestive heart failure (CHF) and admitted her to observe her and pull some of the excess fluid out of her. I explained to her and her husband what CHF was and how we treat it. I then admitted her to the hospital and talked with the hospitalist who would manage her for the next day or so.

CHF patients suffer from their heart just not cutting it anymore and they become congested has fluid backs up into the lungs. This makes it difficult to breath and they often have to prop themselves up on several pillows when they sleep to get enough oxygen. If they lay flat on their back their lungs become more congested due to gravity making it even harder to breath. Often a classic diagnostic question will be "How many pillows do you sleep on?" There are a few different ways to treat CHF all of which entail helping the heart to better do its job.