Congestive Heart Failure: A Comprehensive Case Study and Analysis

This report presents a comprehensive case study on Congestive Heart Failure (CHF), examining the various factors contributing to its development, including myocardial infarction and high blood pressure. The case study details the symptoms experienced by a patient, such as shortness of breath, swelling, nausea, dizziness, and cold extremities, and explains the underlying pathophysiology of each. Furthermore, the report explores the pharmacological interventions used in CHF management, specifically digitalis glycosides and ACE inhibitors, detailing their mechanisms of action. The final section outlines nursing care strategies, including the importance of supplemental oxygen, vital sign monitoring, medication management, and the use of techniques like electric thoracic bioimpedance for cardiac output measurement. References to supporting research are included to validate the information provided.

Running head: CONGESTIVE HEART FAILURE
Congestive Heart Failure
Name of the Student
Name of the University
Author Note

1CONGESTIVE HEART FAILURE
Part 1
Several causes can lead to the development of CHF. One of the important causes
behind the development of the CHF is previous reported cases of myocardial infarction
(Graham et al., 2010). According to the reports published by Graham et al. (2010), CHF is
common among the 50% of the patients who have previously reported cases of myocardial
infarction (MI). MI is also defined as heart attack or an irreversible death of the heart muscle
arising out of the lack of adequate oxygen supply. Since the body was previously suffering
from the lack of adequate oxygen within the body, there occurs immense stress over the heart
muscles and vessels in pumping blood. These increases in the stress of the heart muscles
create strain and thereby hampering their elasticity and all these cumulates towards the
development of CHF (Graham et al., 2010). Mrs. McKenzie has developed MI at the age of
65 and that might be cited as a reason behind the development of CHF at 77 years of her age.
One of the important risk factors behind the development of CHF poorly controlled
high blood pressure (Cooper-DeHoff et al., 2010). According to Cooper-DeHoff et al. (2010),
prolong report of high blood pressure results in the formation of left ventricular hypertrophy
along with thickening of the heart muscles and this results in inadequate relaxation of heart
muscles along with irregular heart beat and thereby leading to the generation of CHF.
Moreover, prolong cases of high blood pressure makes it extremely difficult of the heart to
meet the oxygen demand of all the organs of the body especially during exercise and as a
result, the heart rate increases. These frequent cases of increase in heart rate along with
deficiency of oxygen supply to all the organs of the body ultimately lead to the development
of CHF (Cooper-DeHoff et al., 2010). Mrs. McKenzi has high blood pressure (170/100 mm
Hg) and it was also reported that she suffers from shortness of breath and this increases when
she does gardening and all these lead to the development of CHF. Age is another factor

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which has increased the risk factor of people like Mrs. McKenzi to develop CHF (Bui,
Horwich & Fonarow, 2011).
Apart from damaging the physical health of the individual, CHF, also cast a
significant impact on the mental health of the patients and this contribute to emotional
burden. People with CHF, fails to perform their daily living activity due to their shortness of
breath and thus they become dependent on other creating poor self-esteem. Moreover, CHF
demands regular monitoring along with costly medication, which creates both mental and
physical burden over the family members (Rutledge et al., 2013).
Part 2
Following the case study of Mrs. McKinzie, it can be stated that her shortness of
breath, swelling of ankles, nausea and dizziness, cold feet and high blood pressure are main
symptoms of CHF. Below mentioned is the pathophisiology of the each symptom.
Symptoms Pathophysiology
Shortness of breath CHF is defined as the difficulty of heart to
supply adequate oxygen to the different
organs of the body. This lack of adequate
oxygen leads to the development of shortness
of breath. In CHF the fluid backs up into the
lungs and this interferes with the oxygen
getting into the blood thereby causing
dyspnea while at rest and orthopnea at night
(Kemp &Conte, 2012).
Swelling of ankles Edema is common symptoms of CHF which
leads to the development of swelling of

3CONGESTIVE HEART FAILURE
ankles. Edema generally occurs due to the
activation of humoral and non-humoral
mechanism promoting re-absorption of the
sodium and water from the kidneys and
thereby increasing the body fluid
concentration. As the right ventricular side of
the heart begins to malfunction because of
CHF, the fluid retention initiations and the
extra fluid gets collected at the lower part of
the body, feet (Kemp &nd Conte, 2012).
Nausea and Dizziness CHF leads to persistent tiredness along with
difficulty in performing daily living activities
because arising persistent tiredness. nausea
and dizziness arise out of fatigue and can be
regarded as the first symptom of CHF. The
neurologic reason behind the development of
nausea is related with the emetic centre of the
brain, which occurs due to the lack of oxygen
supply (Kemp & Conte, 2012). According to
Kemp and Conte (2012), the onset of nauseas
may be attributed by the change in the level
of vasopressin (common in CHF).
Cold feet and finger tips According to Kemp and Conte (2012),
feeling of cold in the extremities happens
because the body is circulating the majority

4CONGESTIVE HEART FAILURE
of available blood to the brain and other vital
organs in order to compensate the reduced
ability of heart to pump adequate blood to the
different parts of the body.
High blood pressure In CHF there occurs fluid build up within the
body and increase in thickening of the heart
muscle, this increases the labour of the heart
to pump the blood to the different parts of the
body leading to increase in blood pressure
(Kemp & Conte, 2012).
Part 3
Digitalis glycosides
According to Ambrosy et al. (2014), digitalis glycosides is used for people who are
suffering from heart failure which results out of left-ventricular systolic dysfunction. Digitalis
glycosides is given along with standard CHF theray like angiotensin-converting enzyme
(ACE) inhibitors, beta-blockers and diuretics (Ambrosy et al., 2014). Digitalis glycosides
works via inhibition of Na+/K+ ATPAse in the myocardium. Inhibition of Na+/K+ ATPase
increases the intracellular level of sodium resulting in a decrease of sodium-calcium
exchanger’s activity. Lack of activity of sodium-calcium exchanger increases the intracellular
concentration of calcium ion and this lengthens phase 4 and phase 0 of cardiac action
potential, which leads to the decrease in heart rate. Increase in intracellular Ca2+ ions
increases the concentration of Ca2+ ion the sarcoplasmic reticulum. Ca2+ ion in the

5CONGESTIVE HEART FAILURE
sarcoplasmic reticulum is released during the action potential and thereby increasing the
contractility of the heart without increasing heart’s energy expenditure (Ambrosy et al.,
2014).
ACE inhibitors
ACE inhibitors reduce the formation of heart damaging hormones. ACR inhibitors
have also been found to decrease the workload of the heart via decreasing blood pressure.
The main action of ACE inhibitors is it blocks the formation of angiostenin II via blocking
the conversion of angiostenin to angiostenin II. Angiostenin II is mainly responsible for the
narrowing of the blood vessels and thereby increasing the blood pressure. Thus, decrease in
the formation of angiostenin II prevents the narrowing of the blood pressure and this in turn
prevents the vasoconstriction and thereby causing relaxation of the heart muscles and overall
decrease in heart load and subsequent blood pressure (van Vark et al., 2012). ACE inhibitors
also work via controlling rennin-anngiostenin-aldosterone system (RAAS) and this in turn
controls the fluctuations of blood pressure and the fluid balance of the body. Proper control of
the fluid balance of the body, decreases the fluid retention in the lower extremities and
thereby reducing the load of the heart to pump blood with more pressure (van Vark et al.,
2012).
Part 4:
It was important to design an effective nursing care strategy for a patient admitted to
emergency care department with complaints of potential congestive heart failure. During
designing the effective nursing plans and interventions for the patient, some of the clinical
conditions need to be taken into consideration such as the current medications of the patient
along with effectively monitoring the test results from the physical examination of the
patient. The ECG recordings of Mrs. Mckenzie showed sinus bradycardia , whereas the chest

6CONGESTIVE HEART FAILURE
x-ray depicted cardiac enlargement and lower lobe infiltrates. In this case, the condition of
lower lobe infiltrates could be referred to mycoplasma pneumonia (Carthon, Lasater, Sloane,
& Kutney-Lee, 2015). A number of care plans and interventions could be designed for the
patient depending upon the need. Some of these have been discussed in order of priorities
such as administering supplemental oxygen. The patient had a history of myocardial
infarction and had been complaining of chest pain and shortness of breath. The tests reported
the presence of lower limb infiltrates which could be due to early stage pneumonia.
Therefore, putting the patient on supplemental oxygen could have reduced the chances of
occurrence of hypoxia (Hemphill et al., 2015). Since the patient had reported sinus
bachycardia and recorded an abnormally low heart rate of 54 beats per minute. Thus, apical
pulse monitoring on every hourly basis could help in keeping a record of any abnormality
within the heart rate of the patient (Buck et al., 2015). The nurse should also keep a record of
the vital signs of the patient such as awareness of surroundings and responsiveness. The
condition of the patient could be followed up with the help of the ABCD pathway; where A
refers to airway, b breathing, c- cardiopulmonary resuscitation and D- disability and E-
exposure. From the diagnosis, it was confirmed that Mrs. Mckeinze had potential heart
failure. Therefore, apart from the interventions mentioned above the nurse needs to focus
upon the medication plans of the patient. Some of the medications, which were offered to the
patient over here are – digitoxin, frusemide, analine etc. The digitoxin helped in prolonging
the refractory period of the atrioventricualr junction and helped to increase the cardiac
efficiency output. The frusemide administration would help in curing the fluid buildup due to
heart failure. Therefore, providing the patient with such medication would have been
beneficial as the patient showed signs of cardiac enlargement, which could be entitled to the
fluid buildup.

7CONGESTIVE HEART FAILURE
The nurse can use electric thoracic bioimpedance technique (TEB) for measuring the
cardiac output (Riegel, Dickson & Faulkner, 2016). The test should be repeated within 72
hours in order to analyze the overall condition of the patient. In case, the patient had shown
abnormality immediate referral of the patient to be done. Additionally, a chart needs to be
maintained for effective medication management of the patient.

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References
Ambrosy, A. P., Butler, J., Ahmed, A., Vaduganathan, M., Van Veldhuisen, D. J., Colucci,
W. S., & Gheorghiade, M. (2014). The use of digoxin in patients with worsening
chronic heart failure: reconsidering an old drug to reduce hospital admissions. Journal
of the American College of Cardiology, 63(18), 1823-1832.
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., ... &
Strachan, P. H. (2015). Caregivers’ contributions to heart failure self-care: a
systematic review. European Journal of Cardiovascular Nursing, 14(1), 79-89.
Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart
failure. Nature Reviews Cardiology, 8(1), 30.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of
hospital work environments and missed nursing care is linked to heart failure
readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, bmjqs-2014.
Cooper-DeHoff, R. M., Gong, Y., Handberg, E. M., Bavry, A. A., Denardo, S. J., Bakris, G.
L., & Pepine, C. J. (2010). Tight blood pressure control and cardiovascular outcomes
among hypertensive patients with diabetes and coronary artery disease. Jama, 304(1),
61-68.
Graham, D. J., Ouellet-Hellstrom, R., MaCurdy, T. E., Ali, F., Sholley, C., Worrall, C., &
Kelman, J. A. (2010). Risk of acute myocardial infarction, stroke, heart failure, and
death in elderly Medicare patients treated with rosiglitazone or
pioglitazone. Jama, 304(4), 411-418.