Treatment and Management of Cardiac Failure - Case Study Example

Treatment and Management of Cardiac Failure Name: Professor: Institution: Date: Introduction Cardiac failure (CCF) is a condition that occurs when the heart is not capable of pumping blood at a rate and quantity that will be able to meet the demand by the body (Ward & Witham, 2009). The condition is caused by failed pumping and heart failure. In people with CCF, the left ventricle fails to empty properly, resulting into increased blood pressure in the upper chambers and closer veins. In persons with heart failure, the left ventricle fails to undergo relaxation leading to a blood back-pressure build up. This article looks into a case study of a patient experiencing cardiac failure, from physiology of the condition to diagnosis, to treatment and management of the condition. Patient History and Presentation Jones (pseudonym), a 57 year old male presents at the Emergency Department and complains of shortness of breath for the past four days. The condition has been progressively getting worse each day, and more severe when he lies down with exertion or walking stairs or when involved in other strenuous activities. A day prior to presentation, he woke up at about 3 A.M short of breath and spend the rest of the night in his recliner. In the morning PTA, he started to become breathless when he simply walked from room to room in his house. He also complains of coughing and dyspnea, and also notes that there is increased bilateral swelling in his legs. However, he is alert, responds to instructions and cooperates well. The patient was previously on perindopril that ceased 6 months ago and is allergic to -lactam antimicrobials. Three years ago, the patient had a coronary artery by-pass surgery, and has remained asymptotic since the event with mild sub-sternal chest pain. Jones also has a history of prior myocardial infraction, diabetes and hypertension. Jones is a truck driver and has been doing this job for the past 15 years. He states that he does not smoke cigarettes nor take alcohol. Jones lives a sedentary lifestyle, with no engagement in any physical activities. At home, he stays with his family; his wife, two daughters and a son. The daughters are aged 24 years and 20 years, while the son, who is the youngest in the family is 14 years old. Physiology The cardiovascular system comprises of the heart, blood and the blood vessels. The heart is responsible for maintaining the required oxygen circulation around the vascular network system in the human body. The blood vessels are oriented into pulmonary circulation and systematic circulation. During the heart contraction, blood is pumped into both loops (Royal College of Physicians of London, 2003). The cardiac muscle (myocardium) is a special muscle that consists of isolated cells that are joined by electrical connections. When each individual cell contracts, there is an increase in intracellular calcium concentration. This leads to a spontaneous depolarization which generates a wave that travels through the electrical connection of the cells across the myocardium. Myocardium is intrinsically elastic, allowing cardiac output without a rise in the myocardial oxygen demand or variation in mean arterial pressure (Poppas & Rounds, 2002). The cardiovascular network affects other body systems, such as, renal, respiratory and digestive system. The primary functions of the respiratory system are: supply of oxygen, maintaining blood hemostasis, removal of wastes from the body cells, and maintaining heat exchange. The renal system carries the function of filtering bloodstream to get rid of wastes that are expelled as urine. The kidney system plays a significant role in maintaining stable electrolyte levels, and produces hormones that assist in maintaining blood pressure (Arai & Greenberg, 1990). The primary role of the digestive system is to process and absorb nutrients. Another important part of the cardiovascular system is the lymphatic system. Blood flow into the body tissues may bring in bacteria. The lymphatic system protects the tissues by picking up wastes and toxins from the tissues back to the blood circulation system. Cardiac failure occurs when the heart cannot pump blood to sufficiently meet the requirements of the body’s physiological processes. This causes building up of fluids, particularly in the lungs, liver, arms and legs. The feet may develop swelling, especially when one is standing, and diminishes when one lies down. When the lungs are affected, it may result to coughing and shortness of breath, especially when one is engaged in a physical activity (Gillespie, 2006). CCF is likely to be experienced in individuals with history of high blood pressure or heart attack, congenital heart disease, infections or narrowed arteries. Pathophysiology An estimated 300, 000 Australians suffer from cardiac failure and each year, about 30, 000 new cases are diagnosed every year. Generally, cardiac failure is a disease that is common in older people, with 13 per cent of cases presented to GP coming from individuals aged 65 years and above (Angeja & Grossman, 2003). Between 1996 and 1997, approximately 41, 000 hospitalizations in Australia were reported to be principally diagnosed with congestive heart failure. This contributed to approximately 2% of the total deaths in Australia during that period (Virtual Medical Center, 2015). Incidences of CCF are on the rise and it is predicted that this trend will continue because of two main reasons: One, the advanced modern medicine which has prolonged the lifetime of people with cardiovascular disease, and second, the largest proportion of Australian population comprises of older people, who have a higher prevalence of cardiac failure. The risk factors of cardiac failure among the Australian populations include: anemia, infection, abnormal heart rhythm, rheumatic fever, thyrotoxicosis, endocarditis and myocarditis, heart attack, over-exercise, pulmonary embolism, myocardial infarction and hypertension (McMurray, et al., 2012). Cardiac failure is associated with lower extremity edema, intolerance of physical activity, dyspnea when the patient is at rest and exertion, and shortness of breath. Mr. Jones experiences all these signs and symptoms. Systolic dysfunction, which is characterized by < 40% ejection fraction, is the most common cause of cardiac failure, often resulting from myocardial infarction. Diastolic dysfunction is associated with impairment of the diastolic filling in the left ventricle, and hypertension. The result of all these is a lower cardiac output and consequently, the compensatory neuro-hormone is stimulated to increase the volume of blood circulation, resulting in pulmonary congestion (Hosenpud & Greenberg, 2013). When Mr. Jones’ chest was checked on x-ray, pulmonary congestion was confirmed. Furthermore, crackles were audible from his lungs. Patient Diagnosis and Assessment The diagnostic assessment carried out on the patient include: chest x-ray, abdominal/pelvic x-ray, and lab tests. It was noticed that Mr. Jones had low levels of hemoglobin, which indicates a low oxygen-carrying ability of the red blood cells. Low hemoglobin in cardiac failure is associated with excess fluid volume. The blood urea nitrogen was higher, indicating a decrease in the rate of glomerular filtration rate. Consequently, this means that the kidneys are not functioning normally and this is the cause of excess fluid volume (Angeja & Grossman, 2003). More compressive test results can be seen in the appendix. Chest x-ray was performed to assess shortness in breath. The results obtained revealed that there was pulmonary congestion. An x-ray on the patient’s abdomen indicated that fluids were accumulated in his lower abdomen. The physician’s intervention actions for Jones’ situation were fluid restriction – strictly Read More