Connie is alert and oriented.

Vital Signs:
- BP = 124/82
- P = 88 bpm and regular
- T = 98.1
- O₂ Sat = 93% RA
- Wt = 195 pounds; Ht = 5' 7"; BMI = 30.5

Significant findings on exam include:
- Central venous pressure (CVP) assessed at approximately 10 cm H₂O
- S3 and a 2/6 systolic murmur heard over the mitral area upon auscultation
- Presence of hepatojugular reflux (HJR)
- 1+ pitting edema to mid shin bilaterally

EKG:
- Normal sinus rhythm with no acute abnormalities
- Heart rate of 90

Question:
What additional diagnostics would you like to obtain? Provide rationale for each diagnostic.

Based on Connie's clinical presentation, here are additional diagnostics that may be warranted, along with their rationale: Echocardiogram, Chest X-ray and B-type natriuretic peptide (BNP) levels

1. Echocardiogram: An echocardiogram can provide detailed imaging of the heart's structure and function. It can help assess for structural abnormalities, such as valvular disease (which may be suggested by the systolic murmur), cardiac function (including ejection fraction), and the presence of any fluid around the heart (pericardial effusion).

2. Chest X-ray: A chest X-ray can provide valuable information about the size and shape of the heart, as well as the presence of any pulmonary congestion or fluid in the lungs. It can help assess for signs of heart failure, such as cardiomegaly or pulmonary edema. Given Connie's symptoms and physical exam findings, a chest X-ray can help evaluate for signs of congestive heart failure.

3. B-type natriuretic peptide (BNP) levels: BNP is a hormone produced by the heart in response to increased stretching of the heart muscle, such as in cases of heart failure. Elevated BNP levels can indicate heart failure and may help confirm the diagnosis in conjunction with other clinical findings.