Clinical Decision Support

Patient Information

Current case under review

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Full name
Michael Johnson
Age / DOB
64 years / 05/12/1961
Current complaint
Progressive dyspnea on exertion, fatigue, peripheral edema
Key history
HTN Type 2 DM CAD COPD Prior MI (2020)

AI-Generated Differential Diagnosis

DEfRAG Analysis Complete

Congestive Heart Failure

87%

Key supporting findings:

  • BNP elevated at 825 pg/mL (measured today)
  • Ejection fraction 35% on recent echo
  • Bilateral crackles on lung exam
  • JVD and peripheral edema present

COPD Exacerbation

42%

Key supporting findings:

  • History of COPD with recent albuterol use increase
  • Decreased breath sounds bilaterally

Pulmonary Embolism

23%

Key supporting findings:

  • D-dimer slightly elevated at 0.65 μg/mL
  • Wells score: 3.0 (moderate risk)

AI Clinical Reasoning

The constellation of symptoms including peripheral edema, elevated BNP, reduced ejection fraction, and pulmonary congestion strongly favor CHF as the primary diagnosis. While the patient's COPD history is relevant, the cardiac biomarkers and imaging suggest heart failure is the predominant issue requiring immediate management.

Similar Patient Cases

AI-identified cases with comparable presentations

Case #12089

67M, similar comorbidities

93% similarity

Treated with diuretics and ACE inhibitors with good response within 72 hours.

Case #08734

59M, post-MI CHF

78% similarity

Required BiPAP support initially, responded to aggressive diuresis.

Case #15422

70M, CHF with renal impairment

65% similarity

Careful diuresis with renal monitoring led to successful outcome.

AI Treatment Recommendations

Updated 5 minutes ago

Primary Intervention

IV Furosemide

40mg IV push now, then 40mg IV q12h

Evidence Level: Class I, Level A

ACE Inhibitor

Lisinopril 5mg PO daily

Evidence Level: Class I, Level A
Note: Monitor renal function closely; patient has borderline CKD.

Beta Blocker

Carvedilol 3.125mg PO BID

Evidence Level: Class I, Level A

Additional Considerations

Oxygen Therapy

Supplemental O2 to maintain SpO2 > 92%

Sodium Restriction

Limit to < 2g/day

Daily Weight Monitoring

Track fluid status with daily morning weights

Contraindication Analysis

Caution with ACE Inhibitors

Patient's most recent creatinine is 1.4 mg/dL. Start at low dose and monitor renal function in 48-72 hours.

Outcomes Prediction

Based on similar cases and current presentation, the AI model predicts:

  • 89% probability of symptomatic improvement within 72 hours with recommended treatment
  • Expected length of stay: 4-6 days
  • 75% probability of maintaining stable outpatient status with adherence to recommended regimen

Evidence Explorer

Supporting clinical evidence for recommendations

2023 AHA/ACC Guidelines for HF Management

American Heart Association, American College of Cardiology

"Loop diuretics remain the cornerstone of congestion treatment in acute heart failure..."

Meta-analysis: ACE Inhibitors in Heart Failure

New England Journal of Medicine, 2022

"ACE inhibitors showed a 23% reduction in mortality across all studies analyzed (n=12,763)..."

Beta-blockers for Reduced EF Heart Failure

Journal of the American Medical Association, 2023

"Early initiation of beta-blockers was associated with improved long-term outcomes when carefully titrated..."

Interactive Decision Tree

AI reasoning pathway for current diagnostic and treatment recommendations

Symptoms Cardiac Pulmonary CHF CAD COPD PE Treatment Plan AI Clinical Reasoning Pathway 87% Decision Points Selected Pathway

The decision tree shows how the AI analyzed 147 clinical variables from the patient record to arrive at the current recommendations, with each node representing a key decision point in the diagnostic and treatment pathway.

Suggested Specialists

AI-recommended experts for this case

Dr. James Wilson

Cardiology, Heart Failure Specialist

Dr. Maria Rodriguez

Pulmonology

Dr. Robert Chen

Nephrology