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Congestive Heart Failure - Case Study Example

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Case Study: Congestive Heart Failure Name University Case Study: Congestive Heart Failure The case subject Ms. Fischer came to the hospital with three presenting complaints of increased shortness of breath, weight gain and chest pain. She has a history of congestive heart failure (CHF), atrial fibrillation, hypertension and four incidences of hospitalization for aggravation of CHF symptoms…
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Congestive Heart Failure
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Download file to see previous pages The heart failure is divided into systolic dysfunction and diastolic dysfunction. The ejection fraction, the fraction of blood that is pumped out by the contracting heart at the time of systole, determines the type of heart failure an individual is suffering from. Congestive heart failure is characterized by shortness of breath which increases from exertion. Other symptoms include peripheral edema which is caused by fluid retention in the legs. As in the case-study, CHF is associated with hypertension, which is one of the causes for heart failure caused by excessive stretching of the heart muscles. Apart from the clinical presentation of dyspnea, the patient also has 8 pound weight gain, which points out to another etiological factor of obesity which results in the causation of CHF. With the increase in weight, the workload of heart increases and hence the heart muscles weaken leading to CHF. It can also be a factor in exacerbation of CHF (Roberts 2009). The patient also complains of chest pain and is prescribed nitroglycerine ointment, Darvocet and Ibuprofen for her chest pain. Angina pectoris is described as chest pain caused by ischemia of the myocardium. The angina pectoris is associated with several risk factors which include family history, diabetes mellitus, hypertension, old age and hyperlipidemia. As evident from the patient’s history, she has associated complaints of hypertension and also an increased amount of weight for which she is being given a lipid lowering agent, Zocar 50mg once a day. The pain or discomfort is experienced retrosternal which extends to the shoulders, arms and jaws as well. The triggering factors might include emotional stress, exertion, post-meal or excessive cold (Griffin & Topol 2009). Hypertension is another complaint and she is being given Minipres and Calan once a day for lowering her blood pressure. Hypertension is one of the major risk factors for heart failure and is defined as a systolic and diastolic blood pressure of 140/90 or greater than that. A complete history about patient’s lifestyle and daily habits will help in evaluating the etiology of hypertension (Toth & Cannon 2010). Atrial fibrillation is the fourth pathology evident from the patient’s case study. It results in tachyarrhythmia which presents as palpitations, dizziness, and shortness of breath. Less commonly the patients will manifest with chest pain or pulmonary edema. Its association with congestive heart failure, advanced age and hypertension can be explained by the reduced atrial contractions which result in atrial myolysis and defective calcium channels leading to abnormal sympathetic innervations at a cellular level (Griffin & Topol 2009). Digoxin is the most widely used cardiac glycoside for the treatment of heart failure. It promotes heart contractility and also regulates the calcium concentrations in the cytosol. With the action of Digoxin, the heart pumps blood with more force, almost resembling that of the normal heart. However, an important adverse effect includes hypokalemia which may lead to digitalis toxicity. Therefore, the patients are also prescribed potassium supplementation along with digoxin. Furosemide is a loop diuretic which increases the urine output and hence reduces the excessive water ...Download file to see next pagesRead More
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