Case Study for a Heart Failure

Running Head: CASE STUDY 1
Case Study for a Heart Failure
Student’s Name:
Name of the Institution:

CASE STUDY 2
Case Study for a Heart Failure
Pathophysiology
Cardiogenic Shock
Cardiogenic shock represents the heart’s inability to sufficiently supply enough blood to
the vital organs of the body. It is fatal if the steps are not taken to manage it. Signs and symptoms
of this condition include; rapid breathing, severe shortness of breath, tachycardia, pale skin, cold
hands and feet, low blood pressure (Voga, 2008). A Major cause of this kind of shock is
insufficient oxygen-rich blood circulating in the left ventricle of the heart. As for our case study,
Mrs. X displays enough of the above mentioned signs and symptoms to conclude she is
undergoing a cardiogenic shock. The CXR test requested by the medical officer shows an
enlarged heart, further proof of cardiogenic shock existence (Voga, 2008).
Mrs. X was subjected to various examination when she arrived at the hospital. Among the
trials, she was subjected to include: the AST, ALT, ALP, and Albumin tests. These tests
investigate the performance of the liver to deduce any liver damage. The average range values of
these tests are AST (9-32 U/L for females), ALT (7-55 U/L), and ALP (45-115 U/L). Results
displayed by Mrs. X were well off the normal range indicating proof of liver damage; this could
translate that the liver is not getting enough oxygen-rich blood. Conclusively, the patient could
be experiencing a cardiogenic shock (Voga, 2008).
Heart Failure
Heart failure can be diagnosed when the heart muscle fails to pump blood as efficiently
as it should. Among the signs and symptoms of this condition include, shortness of breath even
when lying down, fatigue and weakness, swelling especially ankles and feet, irregular heartbeat,

CASE STUDY 3
chest pains, and reduced appetite (Smiseth & Tendera, 2008). In our case study, Mrs. X shows
most of these symptoms and signs; this paper focuses on the shortness of breath and swelling of
ankles to illustrate the pathophysiology of heart failure.
There are numerous reasons for heart failure, the most common underlying problem in
the modern era being ventricular dysfunction. Myocardial infarction and hypertension contribute
markedly to this dysfunction. The myocardial infarction is responsible for systolic ventricular
dysfunction while hypertension leads to diastolic dysfunction (Smiseth & Tendera, 2008).
Critically, hypertension- a condition that Mrs. X had in her childhood- represents a more
common aetiology in women than men (Kemp & Conte, 2012).
Furthermore, idiopathic dilated cardiomyopathy presents another major cause of systolic
dysfunction that is commonly encountered. This condition represents 15-20% of reported cases
of heart failure globally. The syndrome can be accelerated by a previous or ongoing excessive
consumption of alcohol. Mrs. X enjoyed 5-6 beers a day, which in part is to blame for her state
deterioration. What is not clear is the relationship between diabetes and the systolic and diastolic
dysfunction, literature has, however, pointed to a higher susceptibility to heart failure as a result
of diabetes (Gardner, McDonagh, & Walker, 2014). Correspondingly, her non-compliance to
treat diabetes put her at this risk of heart failure.
Incredibly, as the heart fails the body in response develops specific adaptation
mechanisms referred to as the compensatory mechanisms (Peacock, 2017). These occur in an
attempt to restore the heart performing its adequate function of supplying oxygen-rich blood.
These compensatory mechanisms include Frank-Starling mechanism which aims to have the
cardiac output increased, ventricular remodeling has the objective of increasing ventricular
volume, and activation of neurohormonal systems ensures tissue perfusion (Maclver & Dayer,

CASE STUDY 4
2012). Initially, these mechanisms help restore the heart’s purpose, but with time they lead to a
vicious cycle of failing the left ventricular even further (Peacock, 2017).
In the case of chronic heart failure, continued attempt to use the compensatory
mechanisms leads to sodium and water retention. Mrs. X registers higher than normal levels of
Sodium in the U&E test and also exhibits a moist cough showing signs of retained sodium and
water (Blankesteijn & Altara, 2015). The adaptations also lead to extraordinarily high pulmonary
capillary and artery pressures resulting in the shortness of breath experienced by the patient.
Also, sodium and water retained in the vascular walls lead to arterial constriction and stiffening.
In turn, this increases the afterload eventually causing the damaged left ventricle to fail further.
Most of the symptoms exhibited by patients of heart failure are due to the compensatory
mechanisms (Blankesteijn & Altara, 2015).
Investigations
The condition of heart failure could be a result of any abnormality ranging from electrical
activity or mechanical function. Each of these failures would require a different kind of
treatment, though they would display similar signs and symptoms. It is always advisable that
before putting a heart failure patient to treatment, to first investigate the aetiology of the failure
to have the right diagnosis (McMurray, Komajda, Anker, & Gardner, 2015). Patients may
display similar symptoms of heart failure but require different treatments due to the difference in
the underlying causes of heart failure. For correct administration of medication; it is crucial to
carry sufficient trials on a patient suspected of heart failure to establish the root cause (Cowan,
2017).