Clinical Case:

An 82-year-old Spanish-speaking female presents to the emergency department (ED) as a referral from her primary care physician when she was noted to have progressive dyspnea during a telehealth visit. Her cardiac conditions include a history of coronary artery bypass grafting, chronic heart failure with reduced ejection fraction (EF=10-15%), atrial fibrillation, severe tricuspid regurgitation with moderate right ventricular dilation and moderate right ventricular systolic dysfunction. Right ventricular systolic pressure at the time of the most recent echocardiogram was 70-75 mmHg.

Her non-cardiovascular comorbidities include type 2 diabetes mellitus, hypertension, chronic kidney disease (stage IV), prior femoral neck fracture and surgery, and a history of metastatic breast cancer being currently treated with an oral antineoplastic agent.

Over the past few months, she has had frequent ED visits for volume overload symptoms. While talking to the patient in English, the ED physician learned of her interest regarding hospice services. He noted through chart review that she has an advanced directive and a physician ordered life sustaining treatment (POLST) of a full code.

The ED physician wished to have a goals of care discussion and being aware of her limited English proficiency (LEP) wished to involve a commonly used professional interpreter service at the institution. However, she refused professional interpreter services and instead suggested to call her son for translation.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Structural Heart Disease, Hypertension

Keywords: Geriatrics, Heart Failure, Aged, 80 and over, Language, Atrial Fibrillation, Physicians, Primary Care, Tricuspid Valve Insufficiency, Diabetes Mellitus, Type 2, Breast Neoplasms, Stroke Volume, Femoral Neck Fractures, Blood Pressure, Dilatation, Translating, Cardiomyopathies, Hypertension, Coronary Artery Bypass, Telemedicine, Emergency Service, Hospital, Dyspnea, Referral and Consultation, Renal Insufficiency, Chronic, Antineoplastic Agents, Patient Care Planning, Nuclear Family

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