Congestive Heart Failure - Case Study Example

?Running Head: CONGESTIVE HEART FAILURE Adult Health II of This research is being submitted on March 24, to ----- in partial fulfilment of the requirements for Adult Health II course. Outline of the Paper I. Introduction of Congestive Heart Failure a. Opening Paragraph b. The purpose of this paper II. Incidence of Congestive Heart Failure in the United States a. Discussion of the Prevalence of CHF b. Statistics of Morbidity and Mortality III. Pathophysiology of Congestive Heart Failure a. In depth discussion of CHF b. The mechanism and resulting physiologic alteration c. The resulting effects on body system d. Citations from Peer Reviewed Articles IV. Analysis of Clinical Findings Manifestations a. Discussion of the Patient’s Clinical Presentation b. Review of Patient’s Clinical Course c. Comparison of this case to pathophysiologic findings in the literature d. Critical Thinking V. Analysis of Laboratory Tests VI. Treatments VII. Outcome Analysis VIII. References Introduction to Congestive Heart Failure Opening paragraph in which the topic is introduced and the content: More than 5 millions of the Americans are suffering from Congestive Heart Failure (CHF) and these people have been in and out from the hospital because of CHF and its clinical sequelae (American Heart Association, 2004). CHF changes lives. It affects the structure of the family and the society as well. Once it strikes the breadwinner of the family, it would mean loss of income and shifting of one’s role in the family. In general, this debilitating disease greatly affects the family and the society as a whole, since any problem that might occur in the family affects the community as well. How severe the condition is determines the impact to the life of a person. The milder CHF is in the life of the person, little does it affect the person’s life. Otherwise, severe form of CHF interfere the activities of daily living of a person and even its simplest activity may prove fatal. Purpose of the Paper: The purpose of this paper is to critically use the author’s knowledge on Congestive Heart Failure (CHF) and to apply the knowledge learned from the literatures at hand and to correlate it clinically from the case of the patient being presented. Incidence of Congestive Heart Failure Discussion of the prevalence of Congestive Heart Failure in the United States: Congestive heart failure is a “serious condition” resulting to a considerable morbidity and mortality (Schocken, et al., 1992). In the US, CHF is an increasing public health concern because of the limited data that identifies the validity in diagnosing CHF (Goff, et al., 2006). Lui and Wallace (2011) noted that although the annual prevalence rate of CHF was 1.6 percent, which is much lower than that of hypertension, the number of average rate of hospitalisation was reversibly higher with high rate of hospitalisation among the older population belonging to the adults aged 75 and above, compared to the younger population who have the least group of individuals being hospitalized (Lui and Wallace, 2011). According to the National Heart Lung and Blood Institute (2012), the prevalence rate of CHF is increasing and an estimated 4.8 million Americans were diagnosed to have CHF and likewise, an increasing incidence of prevalence rate of hospitalizations and deaths secondary to CHF is increasing (National Heart Lung and Blood Institute, 2012). The incidence of new cases of mortality of 400,000 secondary to CHF is increasing each year and others were due to its complications (National Heart Lung and Blood Institute, 2012). Statistics of Morbidity and Mortality: CHF occurs equally in both men and women but is more prevalent in descent other than white Americans such as African – American, Hispanics, and American - Indians (Cleveland Clinic, 2011). About 1 million are hospitalized each year in the United States due to CHF and around 30 – 60 percent of these populations are readmitted due to the same problem (Cleveland Clinic, 2011). The mortality rate of CHF in about two years time which approaches that of the mortality of malignancy is now 35 - 45 percent and according to the American Heart Association, nearly 53,000 of death each year in the U.S. is caused by CHF (Figueroa and Peters, 2006 and Cleveland Clinic, 2011). Cleveland Clinic (2011) noted that the increasing rate of morbidity and mortality is due to the delayed diagnosis and treatment of patients who often account tiredness and shortness of breathing to other factors such us aging process and other medical condition, who consequently failed to seek immediate treatment. As a result, by the time they are diagnosed, the disease is already in the advance state that it will be difficult for the patient to return to the normal condition. Pathophysiology of Congestive Heart Failure An in depth discussion of Congestive Heart Failure: Congestive heart failure is a term referred to “heart failure” accompanied by overload of fluids (Cleveland Clinic, 2011). The common understanding about a person having a heart failure is that their heart has stopped or failed its function; however, the true meaning of a heart failure is that the heart is not working normally or efficiently as expected, and is weakly pumping. This lead to build up of fluids in the lungs and eventually, to other organs that would eventually manifest as shortness of breathing (Cleveland Clinic, 2011). The Mechanism (cause) and Resulting Physiologic Alterations: CHF is caused by medical conditions such as coronary arterial disease (heart attack), hypertension, diabetes, or defective heart valve resulting to weakened muscles of the heart (Cleveland, 2011). CHF syndrome takes place as a consequence of cardiac structure, function, rhythm and conduction abnormalities (Figueroa and Peters, 2006). Ventricular dysfunction resulting from myocardial dysfunction, hypertension, or both, accounts for the majority of causes of CHF in the developed countries. Additionally, it is also caused by degenerative disease of the valve, or idiopathic or alcoholic cardiomyopathy (Figueroa and Peters, 2006). Comorbidities of CHF such as renal dysfunction or other conditions (hypertension or diabetes mellitus) that occur with the disease in the elderly reportedly results to heart failure (Figueroa and Peters, 2006). Other theory notes that long standing abuse of alcohol as well as other unknown causes of CHF accounts as the precipitating factor of CHF (Kulick, 2012). CHF is an inability of the heart to maintain adequate delivery of oxygen to the cells and the systemic response that attempts to compensate to this inadequacy (Figueroa and Peters, 2006). Others accounts CHF as an inherited disease or caused by an infection, thyroid disease, or drug abuse (Cleveland, 2011). Physiologically, a patient with CHF is presenting with systolic heart failure which occurs when the muscle of the heart contracts with a little force on it causing less oxygen supply to the body as a result of decreased pumping capacity of the heart (Cleveland, 2011). “Heart failure with preserved ejection fraction” is another physiologic condition that occurs with the heart normally contracting but the blood is pumped out lesser than normal since the muscle of the heart does not properly relax to allow the chamber to fill in adequate blood between each beat. The diagnosis of CHF secondary to the systolic heart failure can be confirmed by an ejection fraction of less than 40 percent (Cleveland, 2011). Discussion of the Resulting Effects to Additional Body Systems/organs: Kulick (2012) noted that CHF also affects parts of the body other than the heart. Due to weakening of the heart muscle, the kidneys were unable to receive enough blood supply resulting to diminished function of the kidney and fluid retention secondary to inability to excrete salt and water normally. Fluid congestion that is also noted in the lungs is otherwise known as pulmonary edema, which results to decrease ability of a person to exercise (Kulick, 2012). CHF also results to inability of the liver to get rid of the toxins in the body as well as its ability to produce proteins that are essential to the body secondary to fluid accumulation in the liver (Kulick, 2012). Also, CHF causes the nutrients and medicines to be absorbed less efficiently in the intestine. CHF also causes edema of the ankles and feet due to accumulation of fluids in the extremities. Kulick (2012) noted that CHF worsens eventually when left untreated and in the long run affect every organ in the body Multiple citations from peer review articles in addition to text books: A journal on respiratory care by Figueroa and Peters (2006) talks about CHF as a common disorder in the clinical practice resulting to a vascular congestion in the lungs and diminished cardiac output. In any of adult patients presenting with dyspnea or any sorts of respiratory failure, CHF should be considered in its differential diagnosis; however, a careful determination of history, physical examination, and chest radiograph often determines the diagnosis of a heart failure. Oftentimes, the accuracy of its diagnosis is improved through serum brain natriuretic peptide measurement and echocardiography. CHF therapy is geared towards the restoration of normal physiology of the heart and the lung as well as the reduction of “hyperadrenergic state.” Furthermore, the combination of an angiotensin – converting enzyme inhibitor and slow alpha blocker titration remains as the cornerstone of CHF treatment. Complications of patients with CHF include that of associated with pulmonary problems. Treatments include continuous positive airway pressure and non invasive positive pressure ventilation. Mark, et al., (2012) noted in a journal entitled Identification of Patients with Coronary Disease at High Risk for Loss of Employment that among patients with coronary artery disease, work disability is nothing but a common scenario as it affects the economic well being and their quality of life. This study was done to make a model that predicts the premature departure of patients with coronary disease from the workforce. An independent cohort was used among patients to validate this study. From the study, it was concluded that with the use of combined medical and nonmedical risk factors, premature departure from work among patients with coronary disease are identified accurately. Tools to identify patients who are at risk for premature work loss were identified from this model used in the study. Analysis of Clinical Findings Manifestations A discussion of the patient’s presentation, duration of symptoms, complications and physical assessment: This is a case of a 67 year old, male, who came in for consult with a complaint of shortness of breathing. The patient is non diabetic but is chronic hypertensive for almost 20 years, and he is taking an antihypertensive medication for more than 10 years. He smoked for more than 30 pack years but stopped smoking for almost 10 years after being diagnosed with Chronic Heart Failure. On physical examination, rales were noted on both lung bases upon auscultation. He also has grade 2 edema on both lower extremities. The chest x-ray findings revealed presence of fluids in both lung fields, which confirmed the patient’s diagnosis of CHF. Initially, the patient was placed on oxygen per nasal canula, nebulised with beta blocker, given diuretics for the edema, and was treated with ACE – inhibitor for his hypertension. As soon as the patient was stabilized, a 12 - lead electrocardiographic tracings and chest x – rays were obtained. Complete blood count, urinalysis, serum electrolytes, glycohemoglobin, and blood lipids were also obtained for testing. Prior to his discharge, the patient was informed to restrict from too much salt and fluid intake since it has a possibility to accumulate in the lungs and other tissues (Kulick, 2012). The fluid intake of the patient was limited to only two quartz per day, and was told to inform the medical practitioner for any weight gain of 2 to 3 pounds (Kulick, 2012). Although this practice was previously avoided, the patient was instructed to exercise daily according to his tolerable limit since exercise reportedly increased the lifespan of patients previously studied (Kulick, 2012). CHF has various symptoms depending on the target organ and its degree of involvement and to which the body has compensated for the weakened heart muscle. Kulick (2012) noted that fatigue is an early symptom that a heart is failing since it is an indicator sensitive of possible CHF. One obvious manifestation of an impending CHF is the diminishing person’s ability to exercise; however, this limitation is not obvious in that particular person (Kulick, 2012). An individual later notice swelling of the ankles, legs, or even abdomen as the body is overloaded with fluids from CHF. The aforementioned, which is referred to as “right sided heart failure,” is due to failure of the right chamber of the heart to pump blood to the lungs to be oxygenated and eventually results to fluid build up in the legs, where they are dependent to gravitational pull (Kulick, 2012). Other mechanisms are right sided heart failure caused by long standing left sided heart failure and severe disease of the lung known as “cor pulmonale” (Kulick, 2012). The most common complication of CHF is the pulmonary complication, which usually presents as apnea and hypoxia (Figueroa and Peters, 2006). How does this case compare to the pathophysiologic findings in the literature: The presentation of the patient in this case is typical that of a patient with CHF. As noted, the patient came in for difficulty of breathing secondary to pulmonary edema as evident in the x-ray and physical examination findings and presence of fluids in both lung fields and edema in the lower extremities. The pathophysiologic presentation of any patients remain parallel to that of what is noted in the literatures since what is always written in the research holds true even to this date. Critical Thinking, Analysis and Synthesis of previous content: A thorough extraction of the medical history and careful physical examination as well as chest radiograph and other diagnostic test should be the basic approach of a medical health practitioner to patients suspected to have a congestive heart failure (Figueroa and Peters, 2006). Although the history alone provides clues towards the diagnosis, it is not conclusive and considered insufficient to conclude that a patient is suffering from CHF as its symptoms can be accounted for by other clinicians as merely fatigue or weakness or edema from other primary source (Figueroa and Peters, 2006). Hence, a careful medical history coupled with physical examination findings and diagnostics rules out other differential diagnosis that might lead a medical practitioner to misdiagnose and mistreat the patient with CHF (Figueroa and Peters, 2006). Analysis of Laboratories/Diagnostic Tests How does the diagnostic phase of treatment compare to what the literature states and How does it fits with the particular condition? The constellation signs and symptoms of CHF confirmed by the findings in the x-ray and other laboratory tests confirm its diagnosis (Figueroa and Peters, 2006 and Kulick, 2012). Also, the pertinent medical history of the patient and physical examination findings leads a medical practitioner diagnose a patient who is suffering from CHF (Kulick, 2012). Other diagnostics used to detect CHF include ECG and echocardiogram, which are very useful in the identification of the activities of the heart (Kulick, 2012). Together with the history of the patient and thorough physical examination findings noted by a medical practitioner, it is inevitable that a patient can be diagnosed and treated properly. Is your case reflective of the incidence and presentation in the literature? The constellation of signs and symptoms of the patient and radiographic findings, together with the medical history and physical examination findings lead to the diagnosis that the patient is suffering from congestive heart failure (Figueroa and Peters, 2006). The clinical presentation of the patient in this case was affirmed that he was actually suffering from CHF when compared that of from the literatures available discussing CHF. The previous medical history of the patient of chronic hypertension and a social history of smoking for 30 pack years which was necessary in the history confirms the diagnosis of CHF. Also, the history, physical examination findings, diagnostic data, and the previous medical history of the patient ruled out its differential diagnosis of acute respiratory failure (Figueroa and Peters, 2006). Treatments Was the patient treated according to national practice standards? It is important to understand the pathophysiological mechanism of CHF to come up to a proper treatment goal (Figueroa and Peters, 2006). Treating the patient properly after a thorough medical examination and diagnostics is necessary to relieve them from debilitating symptoms, to prevent them from unnecessary medical expenses during hospital admissions, and most of all, prolong their life (Figueroa and Peters, 2006). Either nonpharmacologic or pharmacologic treatment modalities were applied according to the standard of national practice set in properly managing the patient. Outcome Analysis Survival Rate and Longevity: The issue of survival rate among patients with CHF is very important. According to the Optimum Heart Health (2012), it is a fact that among individuals’ ages 65 years and above, the leading cause of hospitalization is due to CHF. The Optimum Heart Health also noted that the Framingham study revealed that 30 percent of patients suffering from CHF died in a year following its diagnosis and around 60 percent with the first five years. In the aforementioned study, the survival rate remained constant from 1950s to 1980s; however, as much as they were expecting for an increment of death rate, the opposite were noted, wherein in the 1990s, a decline in the death rate was noted among patients with CHF. An increase in death rate secondary to CHF is expected as the population is ageing and as the people will have a longer life span (Optimum Heart Health, 2012). Return to Labor Force and Disability: It is expected that patients with CHF will be advised by their health care provider to stop working while they are on treatment. As they are physically stabilized, they must be advised to be rehabilitated first prior to their release to the workforce. Otherwise, if the patient is not fit to go back to work, he must be placed in a status of permanent or total disability wherein he will stop working because of his medical condition and will be reassessed further whether or not his disability is work related or not to determine whether any financial support can be provided or not. What was the cost (personal and financial) of this illness to the patient and or community? CHF is a costly problem to the patient, family, and to the community in general. On the part of the patient, the patient becomes incapacitated and is unable to perform his duty at home and in the office. He needs to have someone to do things for him at home since even in doing his simple activity of daily living, he would experience dyspnea. On the other hand, a patient with CHF is expected to stop from his work and this would mean loss of income. This scenario is ironical since even with loss of income on the part of the patient, there is corresponding increase of medical cost and care. Aside from the loss of income, the family also need to spend time with the patient and take care of his needs. Future costs involve readmission of the patient as well as cost for his medications. References American Heart Association. (2004). What is Congestive Heart Failure? Retrieved March 24, 2012, from http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300315.pdf Cleveland Clinic. 2011. Heart Failure. Retrieved March 25, 2012, from http://health.usnews.com/health-conditions/heart-health/congestive-heart-failure Figueroa, M. and Peters, J. (2006). Congestive Heart Failure: Diagnosis, Pathophysiology, Therapy, and Implications for Respiratory Care. Respiratory Care, 51(4): 403-412. Goff, D., Pandey, D., Chan, F., Ortiz, C., and Nichaman, M. (2000). Congestive Heart Failure in the United States: Is There More than Meets the ICD code? The Corpus Christi Heart Project. Archives of Internal Medicine, 160(2): 197-202. Jessup. M., Abraham, W., Casey, W., Feldman, A., and Francis, G. (2009). 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. Retrieved March 26, 2012, from http://circ.ahajournals.org/content/119/14/1977.full.pdf Kulick, D. (2012). Congestive Heart Failure. Retrieved March 24, 2012, from http://www.medicinenet.com/congestive_heart_failure/page2.htm#3whatare Lui, C. and Wallace, S. (2011). A Common Denominator: Calculating Hospitalization Rates for Ambulatory Care–Sensitive Conditions in California. Emerging Infectious Diseases Journal, 8(5): A102. Mark, D., Choi, L., Lee, K., Clapp – Channing, N., Williams, R., Pryor, D., Califf, R., and Hlatky, M. (1992). Identification of Patients with Coronary Disease at High Risk for Loss of Employment (A Prospective Validation Study). Circulation, 86(5): 1485-1494. Optimal Heart Health. 2012. Congestive Heart Failure Survival: Proper Treatment Provides Improvement. Retrieved March 25, 2012, from http://www.optimal-heart-health.com/congestiveheartfailuresurvival.html Schocken, D., Arrieta, M ., Leaverton, P., and Ross, E. (1922). Prevalence and Mortality Rate of Congestive Heart Failure in the United States. Journal of American College of Cardiology, 20(2): 301-306. Read More