When patients with heart failure call their primary-care office (instead of their cardiologist) asking for something to help them sleep, this could be a sign of worsening heart failure.

Additionally, if they ask for something to help their postnasal drip, a more thorough assessment is needed as this may indicate a cough when they lie down, which could be a sign of worsening heart failure. Often these patients do not see their diseases as chronic, and they miss signs of worsening failure. — Susan Taplin, FNP, Nashville, Tenn.

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.

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