Drugs That May Cause or Exacerbate Heart Failure

Running Head: HV3
Assessment
Student Name:....
Student ID:...

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CONCEPT MAP
(Fibrotic, abnormal
and dead myocytes) Diuretic
ACE Inhibiitor
Beta Blocker
(Chronic Pressure Overload,
Resisting forward flow)
Systolic Heart Failure
Causes
High BP, Severe
Hypertension
Coronary Artery
Disease( Ischemia)
Dilated
Cardiomyopathy
Chronic Volume Overload
Pathogenesis
Advanced Aortic Stenosis
Reduced Contractility
Increased Afterload
Systolic
Dysfunction
Clinical Manifestations Diagnosis
ECG
Chest X Ray
BNP
NT-ProBNP
Orthopnea
Dyspnea, High Blood
Pressure
Management
Digoxin- elevates
contraction
Diuretics- Preload
reduction and
removal of excess
fluid
Course of Treatment
Assess the Fluid Retention
Retention No Retention
Prevention
Control Risk Factors, Stop
Alcohol, tobacco use, Treat
CAD & Ischemia, Treat
Hypertension, Hyperlipidemia,
Thyroid and Diabetes,
Excercise, Healthy Diet &
Active Lifestytle
Spironolactone, ARB,
Dogoxin, Hydralazine
and Isosorbide

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Guided Questions
Pathogenesis causing Clinical Manifestations
The systolic heart failure involves a complex mechanism of abnormal function of ventricular
pump and the external factors reducing the use of oxygen in metabolically active muscle cells
(Katz, 2018). According to American Heart Association, the heart failure may be defined as a
complex condition that emerges from any functional or structural cardiac disorder, impairing
the ability of heart to eject or fill the blood (Rivera & Menaker, 2017).
In systolic Heart Failure the heart is unable to pump blood normally so does not squeeze out
enough blood to meet the requirements of body (Colucci, 2018). Systole is the phase of
cardiac cycle in which the heart contracts to eject out blood to the lungs or the body (Thomas
& Wright, 2018). In Systolic Heart failure the heart has extremely lower force of contraction
and ventricular inotropy. Smaller and weaker muscles find it harder to squeeze the blood out
of heart due to which the stroke volume gets reduced. The muscles weaken due to underlying
diseases (like cardiomyopathy, coronary artery disease, development of plague, or valve
diseases) causing death of cardiac muscle cells (or cardiomyocytes) (Howard, 2017). The
walls of the heart get thinner and the ventricles get bigger in size. Due to reduced blood
supply the cardiac muscle cells die off, due to regurgitation and stenosis of the heart valves,
they remain for longer time allowing the reverse flow of blood (Diwakaran & Loscalzo,
2017). The condition may result into abnormal heart rhythm leading to breathlessness.
It becomes harder for the heart to maintain the normal blood supply and the muscle cells
work harder to balance it. This requires more oxygen demand by the cells. However, as the
blood cannot be supplied so efficiently to meet the demand, more muscle cells die off further
reducing the pumping ability of the heart. Ejection fraction of a normal heart is between 55-
70%. However in the patients of heart diseases, it can be between 40-55% . The ejection
fraction below 40% increases the risk of heart failure (Katz, 2018).
In this case study, the patient is very old age and had a history of heart failure two years ago.
Due to underlying cardiac diseases, her heart muscles would be weaker and susceptible to
recurrent dysfunction. She reports breathlessness, severe dyspnea. It shows she had been
suffering from heart diseases. Her oxygen saturation is 85% which shows very reduced level

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of oxygen is passing through the body. Her high Blood Pressure and high pulse rate reflect
Tachycardia. It shows a disruption in normal blood flow due to heart abnormalities. The
primary cause of heart failure in this patient seems to be hypertension due to high Blood
pressure and a history of Cardiac diseases.
The Auscultation of lungs revealed the bilateral basal crackles. The condition may be
associated with infection of bronchi or alveoli, pulmonary edema and fluid retention in heart.
The Bilateral basal crackles reflect the incidence of basal cracks in both the lungs. This
symptom also confirms te presence of excessive fluids in the airways.
The patient’s ECG also confirmed the Atrial Fibrillation which is a kind of abnormal rhythm
of heart that ocurs when the electric impulse emerge from the atrium in an irreular way. The
condition giuves rise to irregular pulse or heartbeat. The proportion of Systolic and diastolic
dysfubction also increases with age. It is 45% in the patients less than 45 years age while
60% in old age people of more than 85 years of age (Rivera & Menaker, 2017)
Mrs. Brown may require care transition at the time of discharge. The nurses need to follows
the medication and recommended strategies through telephonic communications. The nursing
care team should be in touch with Mrs.Brown to promote adherance to the treatment plan.
Mrs.Brown should also be educated about self care measures, lifetsyle changes and the
emdications. After the resolution of acute symptoms, Mrs Brown should be given beta
blockers, Aldosterone Antagonists and ACE inhibitors to minimize the repeated
hospitalizations and mortality risk.
Two Nursing Strategies for Mrs. Brown
After facing such complex issues of Heart Failure, the old patients may find it difficult to self
care after the treatment (Howard, 2017). So, continuous support and expert guidance is
essential to improve their quality of life. The high priority needs of Mrs Brown involve
regular monitoring of vital signs, modifications in the lifestyle of patients, modifications in
her diet, oxygen therapy and administration of medicines (Amakali, 2015). The interventions
are specially developed to fulfil the requirement of symptoms specified by the diagnosis. The
effectiveness of the implementation is evaluated in the evaluation phase of the process.
Therefore the clinical Nursing strategies for the Patients of Heart Disease involve a
coordination of diagnostic examinations with the nursing interventions in accord to the
ethical principles of care (Covie, 2015).

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Regular Monitoring of Vital Signs- The low cardiac output adversely affects the vital signs of
the patient (Lorenzini, 2016). Therefore the nurses need to monitor the vital signs and record
the changes, to further modify the care plans and to report the condition immediately to
physician. The high pulse rate acts as a compensatory mechanism to reduced cardiac output.
The abnormal Blood pressure shows heart congestion. Low saturation level reflects the low
distribution of oxygen. The nurse need to recommend the bed rest and should prohibit
strenuous activities to be performed by Mrs. Brown, which may elevate the oxygen demand
in the body. The Oxygen therapy may be provided to support her body metabolism
(Lorenzini, 2016). The food should be soft and should be given in small portions to prevent
the difficulties faced by the body in digesting it.
Exercise Training - Regular aerobic exercise may improve the cardiac systolic functions of
the Mrs.Brown. It will also improve the ejection fraction and will reduce the symptoms. The
exercise sessions may be interspersed with the recovery phase (Pi & Hu, 2016). In patients
with chronic systolic heart attack, the fatigue and dyspnea reduces the ability to exercise.
Hence it is necessary to enhance the capacity of exercise in older patients. In addition to the
exercise, she may be recommended to take low salt and reduced fat in her diet modification
(Riley, 2015). The diet without salt helps to reduce the risk of fluid retention and fat free diet
helps in reducing the ischemic heart illness.
The nurse should be able to conceptualize the requirements of the clinical care for Mrs.
Brown. In addition to implementing the priorities, the effective pharmacological treatment
with medications will also be helpful in relieving the symptoms of Heart disease.
Mechanism of Action of Two Drugs given to Mrs. Brown
The two drugs given to Mrs. Brown were IV Furosemide (Lasix) and Sublingual Glyceryl
Trinitrate (GTN).
Furosemide is a diuretic medication that blocks the reabsorption of electrolytes like Sodium,
Chlorine and water in the ascending loop of henle and accelerates the water excretion from
the body (Pellicori, Kaur & Clark, 2015). The drug has faster onset and acts within an hour.
It has less time period for diuretic action specifically from 6-8 hours. It improves the venous
vasodilation thus helps to eliminate the fluid retention. Fluid overload or congestion is a

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serious problem faced by the patients of Acute Chronic Herat Disease like Mrs. Brown. The
Diuretics improve the cardiac function and exercise tolerance.
The Sublingual Glyceryl Trinitrate Tablets dissolve rapidly in the mouth and helps to relieve
the symptoms of pain (Divakaran & Loscalzo, 2017). Being an antihypertensive agent, the
medicine will lower down the high systolic blood pressure of Mrs. Brown. Drug will act as
vasodilator and will improve the collateral flow of blood. The drug lowers down the
pulmonary vascular resistance and relaxes the vascular smooth muscles. It dilates the blood
vessels thus improving the flow of blood and oxygen in the body. It helps in Shortness of
Breath and Cardiac congestion improving the flow.

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References
Amakali,K.(2015). Clinical Care for the Patient with Heart Failure: A Nursing Care
Perspective. Cardiol Pharmacol. 4(2).1-5. DOI: 10.4172/2329-6607.1000142
Colucci, W.S.(2018). Pathophysiology of heart failure with reduced ejection fraction:
Hemodynamic alterations and remodelling. Retrieved from
https://www.uptodate.com/contents/pathophysiology-of-heart-failure-with-reduced-
ejection-fraction-hemodynamic-alterations-and-remodeling
Covie, M.R.(2015). Improving care for patients with acute heart failure: before, during and
after hospitalization. ESC Heart Failure.1(2). 110-145.
https://doi.org/10.1002/ehf2.12021
Diwakaran,S. & Loscalzo, J.(2017). The Role of Nitroglycerin and Other Nitrogen Oxides in
Cardiovascular Therapeutics. Journal of American College of Cardiology. 70(19).
2393- 2410. Doi: https://doi.org/10.1016/j.jacc.2017.09.1064
Howard,E.(2017). Heart Failure. London: Springer. Doi: 10.1007/978-1-4471-4219-5_15
Katz,S.D.(2018). Pathophysiology of Chronic Systolic Heart Failure. A View from the
Periphery. Ann Am Thorac Soc. 15(1). S38-S41. doi: 10.1513/AnnalsATS.201710-
789KV
Lorenzini, M.(2016). Integrated care for Heart Failure in Primary Care. Open Access Peer
Reviewed Book. Retrieved from https://www.intechopen.com/books/primary-care-
in-practice-integration-is-needed/integrated-care-for-heart-failure-in-primary-care
Pellicori, P., Kaur, K., & Clark, A. L. (2015). Fluid Management in Patients with Chronic
Heart Failure. Cardiac failure review, 1(2), 90–95. doi:10.15420/cfr.2015.1.2.90

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Pi, H. Y., & Hu, X. (2016). Nursing care in old patients with heart failure: current status and
future perspectives. Journal of geriatric cardiology : JGC, 13(5), 387–390.
doi:10.11909/j.issn.1671-5411.2016.05.019
Riley J. (2015). The Key Roles for the Nurse in Acute Heart Failure Management. Cardiac
failure review, 1(2), 123–127. doi:10.15420/cfr.2015.1.2.123
Rivera,L., & Menaker,J.M., (2018). Systolic and Diastolic Heart Failure. Emergency
Medicine Reports. Retrieved from https://www.reliasmedia.com/articles/140997-
systolic-and-diastolic-heart-failure
Thomas,M. & Wright,P.(2018). Pathophysiology and Management of Heart Failure. Clinical
Pharmacist. Retrieved from https://www.pharmaceutical-journal.com/learning/cpd-
article/pathophysiology-and-management-of-heart-failure/20205742.cpdarticle?
firstPass=false