(pdf) Left Sided Heart Failure

Added on - 17 Feb 2021

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Case study left sidedCongestive Cardiac Failure
Table of ContentsINTRODUCTION...........................................................................................................................1SECTION 1.....................................................................................................................................1Patient background......................................................................................................................1Reasons for admission................................................................................................................1Past medical /surgical history.....................................................................................................1Diagnosis.....................................................................................................................................2Physical examination and expected findings...............................................................................3SECTION 2......................................................................................................................................3Treatment for the diagnosis.........................................................................................................3CONCLUSION...............................................................................................................................4REFERENCES................................................................................................................................5
INTRODUCTIONLeft sided heart failure is known as the process in which pumping power in the leftventricle of the heart is weakened gradually. The patients with heart disease needs advanced careto avoid the condition of heart failure. The conditions such as increased blood pressure, coronaryartery diseases makes heart too weak to perform pumping function effectively (Stillion &Boysen, 2017). The report will analyse the various clinical aspects of left sided heart failure byanalysing a case study. The study will demonstrate the diagnosis and treatment methods of heartfailure by evaluating and exploring the case study.SECTION 1Patient backgroundA 60 year old woman was admitted in the hospital who had sustained anterior andinferior myocardial infarctions. Despite diuretic therapy oedema and fatigue were graduallyrising. The lady was being given 150 mg aspirin, 50 mg captopril (thrice in a day) and 80 mgfrusemid (thrice in a day) along with the dosage of amlodipine and mononitrate daily at once.The lady was admitted from care home and there was progressive increase in breathlessness. Thepractitioner at care home prescribed coamoxiclav and bendrofluazide. The patient also sufferedfrom dyspepsia which was increasing from the last 10 days. Sitting blood pressure of the ladywas 110/70 mm HG. Through both the lung fields late inspiratory crackles and murmur wereheard.Reasons for admissionThe regular fatigue and breathing shortness were observed when the patient was lyingflat. The fluid retention also caused swelling in ankles. From the last 6 days wheezing or chroniccoughing was also observed. The heartbeats were irregular and patient was complaining ofrestlessness and breathing shortness which also caused difficulty in sleeping at nights. Thepatient was also complaining regarding chest pain. When observed the heart rate of the lady wasalso high and heart was beating at very fast rate. The myocardial ischemia also resulted in chestpain and thus poor cardia output was also identified in terms of hypoxemia and hypotension(Porciello& et.al.2016). The transient pulmonary edema was also identified in the patient.Past medical /surgical historyDyspnea or the breathing shortness causes the breathing difficulty in awaken state. In theearly stages of the patient it can occur only during physical activities such as exercises. However1
later on it can occur in rest state as well. Paroxysmal nocturnal dyspnea and orthopnea are veryclosely related to the heart failure. The activation of the J receptors in pulmonary space by edemafluid can be considered as the prime factor for the dyspnea sensation. Tolerance to the symptomsof fatigue is also one of the reason for the heart failure. Thus such patients can be assumed tohave reduced exercise capacity and enhanced fatiguability in skeletal muscles (Lauridsen& et.al.2018). The reduced perfusion in skeletal muscles due to low cardiac output and intrinsic changesin the muscles, endothelial dysfunciton, microcirculation also plays critical role in fatigue.Wheezing or cardiac asthma is also shown in heart failure patients. The edema and congestion ofbronchial wall and hyperresponsiveness causes the obstruction in the airflow which explains thewheezing. Hypopnea alteration can also cause the waning pattern in the breathing sequencewhich is also one of the major factor in contributing the congestive heart failure.DiagnosisLeft sided congestive heart failure enhances the cardiac output. The most common reasonfor the congestive heart failure is myocardial infarctions and artery diseases. It is known as theischemic cardiomyopathy. Dilated cardiomyopathy causes systolic heart failure and can includestress induced, alcohol related, tachycardia medicated and familial cardiomyopathies. Anothercause or heart failure is the valvular heart diseases (Vezzosi & Karsten, S. 2018). It includesmitral valve stenosis, mitral and aortic valve regurgitation. When low pressure is detected by thesympathetic nervous system then norepinephrine and epinephrine levels are increased and itenhances the heart rate and vasoconstriction. It also increases the cardiac output and relieves theheart failure symptoms. Natriuretic peptide are helpful in reducing the hemodynamic effectsduring congestive heart failure.Along with the resuscitation ABC (airways, breathing and circulation) of the patient variousdiagnosis tests were performed. The ECG was used for analysing the ventricle size, blood flowand heart rate. X-ray was also performed for determining the fluid presence in the lungs. Thebreathing shortness may also result from other causes. Thus, to confirm the actual cause B typenatriuretic peptide was performed. In order to get the clear picture of heart functioningechocardiography was performed. The test provided the details of ejection fraction, contractionand blood flow.2
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