A 38-Year-Old Gravid Female at 29 Weeks With Dyspnea on Exertion

A 38-year-old G3P2 at 26 weeks gestation presents with shortness of breath. Pregnancy prior to this presentation was uneventful.

ROS: + Dyspnea at rest, +PND, + LE edema, + 2-3 pillow orthopnea

PMH: Two uncomplicated vaginal deliveries

Medications: Iron supplementation, Prenatal vitamin

SH: ½ ppd tobacco use, no EtOH, no IVDU

FH: No cardiac history

PE: VS: T: 98.2 BP: 143/81 P: 102 O2sat: 99% RA RR: 18
General: Well appearing gravid female in mild respiratory distress
Chest: Bibasilar rales, Cardiac: tachycardic, regular, +S3, no murmur, JVP: 12 cm H2O
Ext: 2+ pitting edema in BLE 2/3 up legs

Labs: Na: 135 K: 4.1 Cl: 107 CO2: 20 BUN 19 Cr: 0.7 Glu: 95 Ca: 8.2
WBC: 10 Hb: 9.2 Hct: 27 Plt: 144
Alb: 2.9 Tbil: 0.6, AlkP: 73 AST: 49 ALT: 58
BNP: 165 pg/ml

ECG: sinus tachycardia at rate of 104

CXR: Lungs clear, heart size normal.

Are BNP elevations normally seen in pregnancy?

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