Congestive Heart Failure: Assessing Symptoms From A Case Study Case Study Samples

A preliminary evaluation of the medical history of the patient presented in the case study curtails the possibility of disease present to congestive heart disease. Symptoms such as shortness of breath or dyspnea, fatigue, and urinary incontinence are some of the common manifestations of congestive heart failure plus its complications. Ruling congestive heart disease in as the main culprit in the patient’s condition, the shortness of breath she experiences may be attributed to the possible pulmonary edema or water retention in the lungs which obstructs normal respiration and causes difficulty and shortness in breathing (Gillespie, 2006). Aside from pulmonary edema, peripheral edema or water retention in the limbs, particularly in the lower limbs, is also complained by the patient describing a “swelling of the legs that seemed unusual”—a common symptom of congestive heart failure (Figueroa and Peters, 2006; Gillespie, 2006). Edema or poor water retention in patients suffering from congestive heart failure is common due to excessive amounts of sodium in the extracellular matrix (Bart, 2009). Contrary to common beliefs, water is not the culprit in the occurrence of edema but the high amount of sodium intake which promotes the congestive symptoms as well as the edema in patients with heart failure conditions as facilitated by the renin-angiotensin-aldosterone (Bart, 2009). Given the patient’s history of inability to resist food high in salt content, this is probably the best suspect behind her developing peripheral edema and worsening pulmonary edema already obstructing her normal respiration. Aside from such observations, fatigue and difficulty in breathing at night were also reported by the patient. Extreme fatigue or weakness is apparent among patients with congestive heart failure due to their dyspnea or shortness of breathing. Urinary incontinence or lack of control in urination was also reported by patient describing it as the inability to wake up at night to urinate. Congestive heart disease also affects the bladder, making it dysfunctional (Tannenbaum and Johnell, 2014). Aside from that, patients who suffer from congestive heart failure mostly belong to older adults and their frail bodies are also often seen as the reason why urinary incontinence takes place (Tannenbaum and Johnell, 2014). The patient also has reported a history of smoking for 10 years. Smoking is one of the most common risk factors that contribute to the emergence and development of heart diseases, including the congestive heart failure (Butler, 2009). As was reported, “smoking is associated with higher left ventricular mass, lower stroke volume, ejection fraction, and impaired ventricular diastolic function” (Butler, 2009, p. 5).
Further analysis of the patient’s case led to more conclusive findings that point the presence of congestive heart disease. The noticeable 92% oxygen saturation, however minimal, still shows the poor pleural perfusion or oxygen distribution among capillaries and veins experienced by the patient which is the sole reason behind her dyspnea whose absence rules out left-ventricular dysfunction (Figueroa and Peters, 2006). Prolonged capillary refill time also indicate the same finding. Aside from such, lack of jugular distention can also be observed. Jugular distention is the single indicator of an overload in the volume of blood that enters the left ventricle (Figueroa and Peters, 2006). Normally, people diagnosed with congestive heart failure have a highly dysfunctional left ventricle (Figueroa and Peters, 2006). In the case of the patient, left ventricle does not seem too impaired as the volume of blood that enters it still seems normal and sufficient. Thoracic cage also did not show asymmetry, suggesting that the heart can still compensate for the early stage of its ventricular dysfunction. The condition of lips, skin, and mucosal openings also suggest that the perfusion experienced by the patient is still manageable.
Medications were also determined for the patient’s condition. Furosemide, nitroglycerine, potassium chloride, Metaprolol, Trazodone, ASA, and Nifedipine are administered to the patients to control symptoms of her disease. Furosemide is a diuretic administered to treat the extensive fluid retention or build-up while nitroglycerine is administered to prevent the occurrence of angina or chest pain usually associated with heart diseases. Although the patient did not complain of chest pain, the medicine will still serve as prophylaxis. Potassium chloride is administered to prevent or treat hypokalemia or extremely low levels of blood potassium common among patients with heart diseases. Metaprolol is a β-blocker which inhibits the angiotensin-converting-enzyme to regulate or minimize the action of renin-angiotensin system and prevent excessive salt retention which contributes to edema and worsen the perfusion (Figueroa and Peters, 2006; Bart, 2009). Trazadone, on the other hand, is an antidepressant administered to prevent or treat depression and other anxiety disorders. ASA or aspirin serves as the main painkiller in case of any intolerable discomfort or pain that the patient might experience in connection to her ailment. Lastly, Nifedipine is used to lower high blood pressure of hypertension to manage the complications that may come with it.
Aside from medications, complete lab tests with emphasis on abnormal values are taken to further analyze and evaluate the patient’s condition. Lower than normal levels of hematocrit, hemoglobin, and erythrocytes suggest a decrease in the iron and oxygen in blood. Increased INR or prothrombin time (blood-clotting time) is a consequence of high levels of platelets. Sodium level, as expected, exceeds normal accounting for the patient’s edema. Potassium is low however, suggesting the need for potassium chloride to prevent hypokalemia as well as its complications. Creatinine and BNP are also abnormally high while urea is abnormally low. Low pH levels suggest acidosis in the blood—another symptom of congestive heart failure. Decreased ejection fraction accounts for decreased blood pumped from the heart. ECG shows sinus rhythm and x-ray also proves fluid in the lungs—pulmonary edema causing the dyspnea.

References

Bart, B.A. (2009). Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure. Circulation: Heart Failure, 2, 499-504. DOI: 10.1161/CIRCHEARTFAILURE.109.863381
Butler, J. (2012). Primary Prevention of Heart Failure. ISRN Cardiology, 2012, 1-5. DOI:10.5402/2012/982417
Figueroa, M.S., and Peters, J.I. (2006). Congestive Heart Failure: Diagnosis, Pathophysiology, Therapy, and Implications for Respiratory Care. Respiratory Care, 51(4), 403-412. Retrieved from http://rc.rcjournal.com/content/51/4/403.full.pdf
Gillespie, N.D. (2006). The diagnosis and management of chronic heart failure in the older patient. British Medical Bulletin, 75 & 76, 49-62. DOI: 10.1093/bmb/ldh060
Tannenbaum, C., and Johnell, K. (2014). Managing Therapeutic Competition in Patients with Heart Failure, Lower Urinary Tract Symptoms and Incontinence. Drugs Aging, 31, 93-101. DOI: 10.1007/s40266-013-0145-1