Case Study: Female Heart Failure

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

Pain was rated 7/10 in severity. Physical examination revealed decreased lumbar range of motion in forward flexion due to pain. Gait was antalgic. She had difficulty with heel walk and toe walk. SLR was positive on the left. Motor exam revealed weakness 4/5 of the extensor hallucis longus and tibialis anterior muscles on the left. Reflex testing was normal. Sensory examination revealed hypoesthetic region over the left L5 distribution to pinprick and light touch. Current medications included Gabapentin, Tramadol, Methocarbamol, Cymbalta and Synthroid. Treatment plan discussed includes lumbar laminectomy, discectomy, foraminotomy and partial facetectomy at L4-5, preoperative medical clearance and post-operative bracing.

Based on the progress report dated 03/02/16 by Dr. Ozaeta, the patient has had a right knee corticosteroid injection one week ago. She had to take a Norco yesterday for right knee pain. She saw Dr. Cantrell, who requested 8 additional physical therapy sessions. She has low back discomfort, notable when sitting. She takes nortriptyline and an antihypertensive.

Per medical report by Dr. Dentico dated 10/15/13, the patient presented with continued pain in the neck. It was stated that she recently started acupuncture treatments and has already completed 12 sessions so far.

A corticosteroid injection was administered to the glenohumeral joint. She should continue with therapy and home exercise program (HEP).

She has some pain with meniscal maneuvers. There is significant crepitus on exam. Range of motion is 0 to 1 to 100.

ECG: sinus tachycardia with waveform abnormalities consistent with LVH, Pronounced Q waves consistent with pulmonary edema.

Based on the progress report dated 04/05/16 by Dr. Fieser, the patient complains of pain in the left knee, left ankle and left foot, associated with numbness and tingling in the left leg/foot, as well as weakness in the left leg. He describes the pain as sharp, cutting, throbbing, dull, aching, pressure-like, cramping, shooting and shocking with muscle pain and pins-and-needles sensation.

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

Diagnosed with Congestive cardiomyopathy implies that the patient’s heart muscle has been debilitated by ailment and cannot sufficiently pump blood through the heart, which can lead to heart failure (“Columbia University Medical Center”, 2016). In this case study, the current situation of a male patient Mr. P., who is 76 years old, and frequently hospitalized with CHF is given. The purpose of this paper is to describe an approach to care with treatment plan recommendation, provide education to both the patient and his family, and a teaching plan.

management have been shown to help reduce the number of readmissions with the key topic being the education of the patient (Hobbs et al., 2016). In designing this program to reduce the readmission for the heart failure patient a review of the literature was completed and follows.

In the American Heart Association (AHA)/American College of Cardiology guidelines1, heart failure (HF) is defined as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. A normal healthy heart is a muscular organ with four chambers, two on the right and two on the left, that pumps blood to the lungs and rest of the body2. The two upper chambers are called atria and the two lower chambers are called ventricles. The right atria take in oxygen-poor blood from the rest of the body and sends it back out to the lungs through the right ventricle where the blood becomes oxygenated. Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. In a patient with heart failure, the heart muscle has been progressively weakened and unable to pump enough blood through to the body.

6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)? (Select all that apply)

M.G., a “frequent fl ier,” is admitted to the emergency department (ED) with a diagnosis of heart failure