Left Heart Failure: A Case Study

Given the current symptoms it seems that A.O is suffering from left heart failure. Dyspnea the medical term for difficulty breathing is often an indicator of left heart failure. The clinical manifestations including dyspnea are caused by pulmonary vascular congestion and poor systemic oxygen perfusion (Huether & McCance, 2012). Other clinical manifestations physicians find with individuals with left heart failure include, coughing up mucus, fatigue, and a decreased urine output. Physicians will also perform a physical examination to check for pulmonary edema by observing the patient for pulmonary effusion, inspiratory crackles or cyanosis (Huether & McCance, 2012). After this examination, the physician would likely order an EKG to confirm
the diagnosis. An EKG of someone with left heart failure displays decreased cardiac output and cardiomegaly (Huether & McCance, 2012). The decreased Cardiac output would be detected by the Baroreceptors, which would then galvanize the sympathetic nervous system, which would increase A.O’s heart rate (Huether & McCance, 2012).
Additionally the hormones involved in the rennin angiotension system work to increase cardiac output by decreasing glomerular filtration and fluid retention (Huether & McCance, 2012). A.O’s recent pedal edema likely implicates that her left-sided heart failure has caused right-sided heart failure. Left -sided heart failure can create right sided-heart failure after an increase in left ventricular pressure is reflected back into the pulmonary circulation (Huether & McCance, 2012). This increased pressure stresses the right ventricle to pump against greater pulmonary and vascular resistance and left ventricular pressure (Eckman, 2013). A.O’s recent symptom of exceptional chest pain is likely caused from angina. To confirm this diagnosis and prevent myocardial infraction the physician would likely perform a few tests on A.O. The first test the doctor will likely be an EKG. The doctor could also possibly perform a stress test. Thirdly, the doctor would also test for normal troponin levels, normal ck and normal myoglobulin (Huether & McCance,
2012). The doctors prescribed A.O several medications including furosemide, potassium chloride, nitroglycerin and digitalis to treat her cardiovascular disease. Physicians prescribe furosemide because it is a diuretic so it inhibits sodium and chloride absorption and while promoting water excretion. This causes a decrease in blood volume/ pressure. This lowered blood pressure then decreases the cardiac workload which allows AO’s heart to pump more effectively (RxList, 2012) The Potassium Chloride A.O is prescribed potassium to replace the potassium lost due to AO’s furosemide or else she could suffer the effects of hypokalemia. The doctors prescribe nitroglycerin because it decreases the cardiac workload by relaxing the smooth muscle that surround the veins and arteries (rx list, 2009). Digitalis is a cardiac glycoside that increases the strength of heart muscle contractions and increase heart blood output (rxlist, 2009). This allows AO’s heart to be more functional while increases cardiac output.
References
Digitalis Effectiveness, Safety, and Drug Interactions on RxList. (2009, January 1). Retrieved December 7, 2014, from http://www.rxlist.com/digitalis/supplements.htm
Eckman, M., & Share, D. (Eds.). (2013). Pathophysiology made incredibly easy! (5th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Huether, S., & McCance, K. (2012). Understanding Pathophysiology (5th ed.). St. Louis, Mo.: Mosby/Elsevier.
Lasix (Furosemide) Drug Information: Description, User Reviews, Drug Side Effects, Interactions - Prescribing Information at RxList. (2012, January 1). Retrieved December 7, 2014, from http://www.rxlist.com/lasix-drug.htm