Anterior crackles: a neglected sign?

Area of Science:

• Cardiology
• Pulmonology
• Internal Medicine

Background:

• Chronic heart failure (CHF) management often focuses on fluid status.
• Exertional dyspnea is a common CHF symptom, typically attributed to pulmonary congestion.

Observation:

• An 83-year-old male with CHF, atrial fibrillation, and right ventricular pacing presented with worsening exertional dyspnea.
• Anterior chest auscultation revealed pulmonary crackles during comfortable supine breathing.
• Filling pressures were documented as low, contradicting typical congestion.

Findings:

• Unrecognized pulmonary fibrosis was identified as the primary cause of dyspnea.
• The findings suggest pulmonary fibrosis masqueraded as heart failure exacerbation.

Implications:

• Diffuse anterior crackles during comfortable breathing in CHF patients may warrant investigation for occult pulmonary fibrosis.
• This highlights the importance of considering alternative diagnoses beyond fluid overload in dyspneic heart failure patients.
• Early identification of pulmonary fibrosis can lead to appropriate management and improved patient outcomes.