Case Study on Heart Failure

This case study discusses the diagnosis, potential complications, and mode of actions of drug administration for a patient with heart failure. The patient was diagnosed with anterolateral myocardial ischemia and was prescribed aspirin, clopidogrel, intravenous morphine, heparin, and fibrinolytic therapy. Read on to learn more.

Running head: CASE STUDY ON HEART FAILURE
Case Study on Heart Failure
Name of the Student
Name of the University
Author Note

1CASE STUDY ON HEART FAILURE
In this assignment, the case study of Mr. Ben is discussed and he was admitted to the
emergency ward with a history of chest pain of two hours. He also complained that, his pain was
radiating towards the left arm along with this, nausea, breath shortness and diaphoresis were
there. From the case study it is seen that, he is a regular smoker and consumer of beers.
Question 1.
From the assessment of Ben Long, he was diagnosed with anterolateral myocardial
ischemia ( MI) and he had a high blood pressure and heart rate. Anterolateral MI are occurred
due to blockage of proximal anterior descending coronary artery (LAD) along with right
coronary artery or left circumflex artery. As Ben is diagnosed with STEMI, it is said that,
STEMI is the result of proximal and complete blockage in coronary artery. STEMI refers to
elevation of ST segments in the 12-lead ECG (Rajiah et al. 2013).
During the anterolateral MI the conduction system of the heart is highly altered. In case
of anterolateral myocardial infarction transient bundle branch block may occur and sometimes it
is associated with the structural damage of the myocardial cells. Along with this, hemorrhage is
in the conduction system is quite common in myocardial infarction. In the fibers of the left
branch, myocytolysis is observed and it is the sign of reversible or irreversible cell damage. In
this case A-V blockage is seen and it causes permanent alteration in the myocardial conduction
system. In case of Ben Long may possible that he may have A-V blockage as he has no evident
Q wave in his ECG and it is sign of defective conduction system due A-V blockage (Elizari,
Baranchuk and Chiale 2013).
Mr. Ben Long may suffer from the potential complications such as fibrillation, heart
block, ventricular tachycardia and also he have the risk of stroke. Along with this, risk of having

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cardiogenic shock is also there as heart is unable to pump enough amount of blood during this
condition (Kutty, Jones and Moorjani 2013).
Question 2.
After diagnosing Mr. Ben Long, doctors have ordered to follow some steps such as
continuation of oxygen, intravenous morphine, fibrinolytic therapy, heparin, aspirin and
clopidogrel. Generally, during anterolateral MI it is recommended that, aspirin should be given
at a very low dose that is 75mg along with clopidogrel 375mg dose (Ray 2014). Aspirin in low
dose helps to irreversibly block the formation of thromboxane A2 in the platelets and as a result
it inhibits the platelet aggregation. Due to this, antiplatelet property aspirin is used to treat
incidence of myocardial infarction. Myocardial infarction is caused mainly due to blockage of
blood vessels and low amount of aspirin helps in reducing the blockage. Clopidogrel is also used
to induce platelet aggregation by preventing them to stick with each other and thus helps to
prevent unnecessary clots. Clopidogrel selectively inhibits the adhesion of ADP to its receptor on
the platelet named P2Y 12 receptor and activate the ADP-mediated GP IIb/ IIIa complex. This
irreversible action is responsible for the platelet aggregation (Ray 2014). Morphine used in
myocardial ischemia patients works by two ways. Firstly, it helps in reducing the chest pain
along with rendering anxiolysis. Secondly, Morphine vasodilates the blood vessels so that, blood
pressure and heart rate can be reduced and demand of myocardial oxygen is lowered (Kubica et
al. 2015). The dose of heparin in case of acute MI is recommended as 4000 unit (bolus),
followed by infusion of heparin (not more than 1000U/hr) (Aleksey et al. 2013). Heparin helps in
preventing unnecessary blood clot formation. In addition, fibrinolytic therapy is also
recommended for Mr. Ben Long. Fibrinolytic therapy is used to treat MI and when there is a clot
inside the blood vessels, it is used to dissolve the clots that act as barrier to the blood flow. This

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fibrinolytic therapy is capable of reestablishing the antegrade blood flow in most of MI patients.
In case of Mr.Ben Long, it is seen that, he has high blood pressure that is 140/90, heart rate that
is 90 beats/min. In this condition morphine will be very much effective as it can reduce the heart
rate and blood pressure and along with also reduce the pain by enhancing the blood flow to the
myocardial tissues. Aspirin and clopidogrel can also be used as it act as an antiplatelet
aggregator. The oxygen therapy will be effective as it will enhance the oxygen supply to the
myocardial tissues. Heparin must be used as it will help in anticoagulation when simultaneous
fibrinolytic therapy is delivered. To give proper care to Mr. Long it is recommended for the
nurses to observe closely as patient is in severe chest pain and he is diagnosed with myocardial
infarction. The drugs he is prescribed should be given intravenously as he may have problem in
swallowing. During the time of STEMI patients’ drug administration the nurse should follow the
drug dose as per the instruction. As the patient has risk of stroke, the nurse should follow the
doctor’s instructions properly and if there is any complications the nurse should immediately
report to the doctor (O'gara et al. 2013).
Question 3.
Mode of actions of drug administration:
The case study represents chest pain of a truck driver Ben, who was experiencing sudden
chest and associated with short breathiness, nausea, and diaphoresis.
Aspirin and clopidogrel :
Mode of action and rationale:
The lower amount of aspirin showed antithrombotic actions by preventing arterial
thrombosis. A study by Ibanez et al. (2017), suggested that aspirin the gold standard antiplatelet
which functions through irreversible inhibition of cyclooxygenase (cox) activity. In order to

4CASE STUDY ON HEART FAILURE
function properly, initial stretching of cardiac muscles prior to contraction is crucial. In intact
heart, the closest approximation of preload is ventricular end diastolic volume. Patient with acute
myocardial infarctions the initial muscle lengthen ( preload ) influences the heart to eject blood
during systole ( afterload) (Bonaca et al. 2015). As observed in this case study, the patient was
experiencing crushing pain, which radiated in his left arm associated with shortness of breath. In
myocardial infarction, myocardial oxygen supply hinders due to the formation of blood in the
coronary artery. Consequently, due to the lack of oxygen supply in the myocardial muscles may
result in heart failure (Eikelboom et al.2017). Therefore, 75 mg of aspirin was given to the
patient with a combination of clopidogrel in order to prevent the blood clot and reduce the
preload , afterload. Clopidogrel functions by blocking platelets from the sticking together and
preventing from producing clots (Hiatt et al. 2017). Since he was experiencing massive chest
pain low dose of aspirin with a combination of clopidogrel was administrated.
Intravenous morphine:
Opioid drugs, typified by morphine, have the potential to produce analgesia, mood
changing, and physical dependence. Motov et al. (2015), suggested that It acts in both central
and peripheral nervous system by binding and activating the opiate receptor, each of which
involves in different brain functions. Consequently, it controls the anxiety level of the patient,
reduces the subsequent heart rate increase followed by a reduction of pain (Ankumah et al.
2017). As observed in this case study, the patient was experiencing ever chest pain, which
transmitted to the left arm of the patient, and despite fibrinolytic therapy, and he developed signs
of left ventricular dysfunction. Therefore, morphine was administrated intravenously to reduce
the anxiety level of the patient by working on the centre nervous system. It helped to reduce the
heart rate of the patient, which might proceed towards heart failure (Motov et al. 2015).
Furthermore, it helped in managing the severe pain he was experiencing for two hours (Hiatt et

5CASE STUDY ON HEART FAILURE
al. 2017). However, morphine also has other side effects such as trouble in breathing, feeling
light-headed and nausea (Ankumah et al. 2017).
Heparin:
Shahzad et al. (2014), suggested that heparin is an injectable anticoagulant that used for
preventing the blood clot in the vessels. According to Han et al. (2015), stated that heparin is
highly sulfated glycosaminoglycan and highly negative charged biological molecule. It acts a
blood thinner that prevents the formation of the clot. Heparin binds to the enzyme inhibitor
antithrombin iii (AT) causing a conformational change that results in the activation through an
increase in the flexibility of the reactive side loop (Shahzad et al. 2014). The activated
antithrombin iii then effectively inactivates thrombin, factor Xa and other proteases. Therefore,
blood clot formation stops within the vessels. As observed in the case study, it was the patient
was experiencing ever chest pain, which transfered to the left arm of the patient, and despite
fibrinolytic therapy, and he developed signs of left ventricular dysfunction. Therefore, heparin
was administrated to the patient for reducing the blood clots of blood vessels of the patient,
which reduced the myocardial oxygen (Han et al. 2015). Consequently, it will increase the blood
supply in heart and reduce the probability of heart failure inpatient.

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