Sharlene Thompson is a 65-year old woman with congestive heart failure. She is seeing her physician, Dr. Miller, today with complaints of increasing dyspnea on exertion and ankle edema. She mentions experiencing anxiety and insomnia frequently during the past two months but adds that both have improved recently.
Mrs. Thompson is taking digoxin, warfarin (Coumadin), a beta-blocker, and ACE (angiotensin converting enzyme) inhibitor, and furosemide (Lasix). Her warfarin dose and INR (international normalized ratio) have been stable for years. However, the results of recent blood work show that her INR has recently risen.
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