Case StudyCardiology #4Congestive Heart FailureKatelyn Gillen

BIOL 3417

4/21/2014

Clinical Case Study

• A 61-year old man enters the emergency room with acute shortness of breath, rapid and noisy wheezing, a productive cough, dyspnea, cyanosis, dysrhythmias, elevated blood pressure, and dizziness.

• You administer an EKG, order a chest X-ray, and run an electrolyte check.

• His tests reveal pulmonary edema, hepatomegaly, renal insufficiency, and severe electrolyte imbalances.

Diagnosis of the Patient• Congestive Heart Failure

The heart is weakened and cannot efficiently meet the needs for the rest of the body.

Causes of Patient’s SymptomsCHF symptoms may be mild to severe. Symptoms can be constant or intermittent and can include:

• Rapid & Noisy Wheezing & Productive Cough: This is lung congestion in which fluid backs up into the lungs which occurs when the heart is unable to efficiently pump enough blood out.

• Dyspnea: is shortness of breath which can occur when exercising or while resting or when lying flat in bed.

• Cyanosis: is bluing of the skin and mucus membranes. This occurs when there is insufficient oxygen in the blood which often occurs when the lungs and heart pump are compromised.

• Dysrhythmias (Heart Arrhythmia): is when the electrical impulses in the heart that coordinate heartbeats are not working properly. This causes the heart to either beat too slow (bradycardia), beat too fast (tachycardia), or beat irregularly which can result in dizziness.

• Elevated Blood Pressure: is due to the heart overworking itself.

Tests Administered• EKG (Electrocardiogram)

• Chest X-ray

• Electrolyte Check – (aka Electrolyte Panel)

.

Patient’s Results• Pulmonary Edema: is a condition caused by excess fluid in the

lungs. Instead of air, fluid collects in the numerous air sacs (the

alveoli) in the lungs, making it difficult to breathe and preventing

oxygen from being absorbed into the bloodstream.

• Hepatomegaly: is an enlarged liver but is not a disease. It is a sign

of an underlying problem, such as liver disease, congestive heart

failure or cancer.

• Renal insufficiency: aka Kidney Failure is when the kidneys no

longer have sufficient ability to carry out their normal functions.

• Severe Electrolyte imbalances: are caused by a deficiency or an

overabundance of minerals in the body. For example, excessive

amounts of potassium and calcium can disrupt the overall balance

and functioning of the nerves, cardiovascular system, and muscles.

What is CHF?Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65.• Heart failure, sometimes known as congestive heart failure (CHF), occurs when your

heart muscle doesn't pump blood as well as it should.

• When the heart’s pumping power is weaker than normal

Blood moves through the heart and body at a slower rate, and pressure in the heart increases.

• When the heart cannot pump enough oxygen and nutrients to meet the body's needs

The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened.

This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently.

• The kidneys may respond by causing the body to retain fluid (water) and salt.

If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. This condition is referred to as congestive heart failure.

Possible Complications of CHF• Heart valve problems. The valves in the heart keep blood

flowing in the proper direction but when they malfunction the heart may become enlarged or it may create pressure in the heart.

• Liver damage. Heart failure can lead to a buildup of fluid

that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.

• Stroke. This occurs when the blood flow through the heart is

slower than in a normal heart, the development of blood clots can increase, which in turn can increase the risk of having a stroke.

• Death!!! If left untreated.

Treatments• Do not smoke, use tobacco products, or drink alcohol.

• Eat a healthy diet.

• Exercise regularly.

• Do not overdo it.

• Recognize signs of decompensation.

• Take your medications as prescribed.

• Get emotional or psychological support.

Although surgery is more risky for people with heart failure, with advancing technology surgery reduces the risks and improves the patient’s outcomes.

Surgeries:

• Coronary artery bypass grafting surgery – (Most Common)

• Heart Valve Surgery

• Implantable left ventricular assist device (LVAD)

• Heart Transplant

• For the Renal Insufficiency, he will need to go on dialysis and possibly get a Kidney transplant.

Prognosis • The prognosis looks promising!

• However, the patient’s future will depend on how well the heart muscle is functioning, the symptoms, and how well the patient responds to the treatment plan.

The patient needs to follow all the treatments prescribed.

The patient should get a "living will” that expresses his desires about the use of medical treatments to prolong his life.

This document should be prepared while he is fully competent in case he is unable to make these decisions at a later time.

• With the right care, CHF will not stop the patient from doing the things he enjoys and having a better lifestyle.

Sources Cited• American Association for Clinical Chemistry. (2001-2014). Lab Tests Online, Electrolytes. Retrieved from:

http://labtestsonline.org/understanding/analytes/electrolytes/tab/test

• (Beardwood, Norma, MBA, M.Ed., RDN, LD, LPC, CEDS, personal communication, March 13, 2014).

• Haines, Cynthia, M.D. (2013). Electrolyte Imbalance. Better Medicine from healthgrades. Retrieved from http://www.localhealth.com/article/electrolyte-imbalance

• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Enlarged Liver. Retrieved from: http://www.mayoclinic.org/diseases-conditions/enlarged-liver/basics/definition/con-20024769

• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Heart Arrhythmia.Retrieved from http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/basics/symptoms/con-20027707

• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Heart Failure. Retrieved from http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/complications/CON-20029801

• Mayo Foundation for Medical Education and Research. (2014). Tests and Procedures, Chest X-Rays. Retrieved from http://www.mayoclinic.org/tests-procedures/chest-x-rays/basics/definition/prc-20013074

• Mayo Foundation for Medical Education and Research. (2014). Tests and Procedures, Electrocardiogram. Retrieved from http://www.mayoclinic.org/tests-procedures/electrocardiogram/basics/definition/prc-20014152

• Renal Insufficiency (n.d.). In Kidney Problems online. Retrieved from http://www.kidney-problem.org/renal-insufficiency.html

• Stöppler, Melissa Conrad, M.D. (2012). Medicine Net. Cyanosis/Turning Blue. Retrieved from http://www.medicinenet.com/cyanosisturning_blue/symptoms.htm

• WebMD. (2005-2014). Medicine Net, Valve Disease Treatment (Heart Valve Surgery). Retrieved fromhttp://www.medicinenet.com/heart_valve_disease_treatment/article.htm#what_is_heart_valve_repair_surgery

• WebMD. (2005-2014). Heart Disease Health Center, Heart Disease and Congestive Heart Failure. Retrieved from http://www.webmd.com/heart-disease/guide-heart-failure

• Yahoo.com. (n.d.). Retrieved from http://images.search.yahoo.com/yhs/search;_ylt= A86.J777aFFT6x8AoXUPxQt.; _ylu=X3oDMTBsOXB2YTRjBHNlYwNzYwRjb2xvA2dxMQR2dGlkAw--?_adv_prop=image&fr=yhs-w3i-synd1&sz=all&va=heart+healthy+living&hspart=w3i&hsimp=yhs-synd1

Questions?