University Hospital: Heart Failure and CAD in Patient J.M. Analysis

This homework assignment presents a comprehensive case study of a 70-year-old patient, J.M., dealing with coronary artery disease (CAD) and heart failure. The assignment analyzes the patient's medical history, including hypertension and previous cardiac catheterization results, and examines the patient's presenting symptoms such as fatigue, shortness of breath, and episodes of dizziness. It also covers the interpretation of laboratory test results, including hemoglobin, hematocrit, and ejection fraction, and discusses potential causes of the patient's condition, such as anemia and hypertension-induced cardiac hypertrophy. The assignment delves into the rationale behind the patient's medication regime, including Enalapril, Furosemide, Carvedilol, Digoxin, and Potassium chloride, and addresses the importance of monitoring potassium levels due to diuretic therapy. Furthermore, the assignment provides insights into lifestyle modifications, such as dietary restrictions and stress management techniques, to help manage the patient's condition. The patient's ejection fraction of 49% is analyzed, and the assignment includes a discussion of the patient's need for a dietitian to assist in medical nutrition therapy, including sodium control and fluid intake management. The assignment also identifies specific signs and symptoms of digoxin toxicity. The assignment provides a solid understanding of heart failure and CAD management in a clinical setting.

Running head: HEART FAILURE AND CAD
HEART FAILURE AND CAD
Name of the Student
Name of the University
Author note

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HEART FAILURE AND CAD
Answer 1
Laboratory test results showed that Hgb (hemoglobin) and Hct count in J.M is abnormal.
In the USA, anemia was diagnosed if the hemoglobin count is less in 12g/dL in females and
13.5g/dL in males (Yancy et al., 2017). J.M had hgb of 11.5g/dL meaning he is suffering from
anemia or sometimes cancer. Normal Hct (Hematocrit) count in women is 37 to 48% and for a
man, it is 45 to 52%. J.M is having Hct count is 37% , confirms low red blood cells, which might
lead to lymphoma or leukemia.
Answer 2
Questions needed to be asked to J.M and his daughter whether he had gained any weight
in the last few days to assume about fluid retention or decrease in urine output. It needs to be
known that whether any palpitations might lead to dizziness. J.M need to answer if he had been
going chest pain. It is highly recommended to know if J.M is in the habit of smoking, which
exposes him to pulmonary and toxin exposure creating the problem in the lungs leading to a
problem in breathing.
Answer 3
The main problem for his heart failure can be hypertension. Hypertension makes the heart
pump harder in contrast to blood vessel resistance. This hypertension causes hypertrophy in
cardiac muscle that can be seen in the CXR study of J.M. it has been seen that J.M is suffering
from Anemia as he is having low Hct and Hgb count. Anemia decreases the amount of oxygen in
the blood and hence heart has to pump more blood to maintain the balance (Florea & Cohn,
2014). Hence, the demand for oxygen increases causing myocardial ischemia.

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HEART FAILURE AND CAD
Answer 4
1. HF (L)
2. HF (R)
3. HF (R)
4. HF (L)
5. HF (R)
6. HF (L)
7. HF (R)
8. HF (R)
9. HF (L)
10. HF (L)
Answer 5
Enalapril: It is an angiotensin converting enzyme (ACE) inhibitor preventing
reabsorption of water and sodium by preventing the secretion of aldosterone. This results in
diuresis leading to the lessening for blood returning to the heart and reduction in the volume.
Therefore, the workload for a heart can be decreased easily (Jolicoceur et al., 2015). Furosemide:
A diuretic loop is given for a decrease in the volume of fluid. Carvedilo: A beta-blocker that
condenses or blocks the stimulation of the sympathetic nervous system of the heart and its
cardioprotective activity. Henceforth, the heart rate is reduced. Digoxin: It is an inotropic and
cardiac glycoside drug. It increases the contractility of myocardial, causing enhancement in
better cardiac output and efficiency (Cannon et al., 2017). Potassium chloride: It is an electrolyte
enhancement. It is given to J.M to substitute potassium that are lost during diuretic therapy.

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HEART FAILURE AND CAD
Answer 6
No Coreg CR would not be given to J.M as the dosage varies and is released slowly.
Answer 7
Calculation:
250 mcg = 0.25 mg
Dose on each tablet is 0.25 mg
0.25mg/tablet = 0.5mg/tablet (x) [medication order for J.M]
x= 2 tablets.
Hence, 2 tablets required.
Answer 8
J.M’s potassium level needs to be monitored. The diuretic makes the potassium be
evacuated along with water and sodium; hence, the supplement for potassium is required.
Although ACE inhibitor causes potassium retention causing hyperkalemia (Hwang, Melenovsky
& Borlaug, 2014). Lowering of potassium makes causes hypokalemia making the patient more
vulnerable to the toxicity of digoxin.
Answer 9
J.M needs to be told that there are various other for potassium intake. It can be taken in
powder or liquid form that can be dissolved in liquid. According to J.M’s preference, the
physician needs to be informed and different formulation must be ordered.

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HEART FAILURE AND CAD
Answer 10
The ejection fraction 49% means that 49% of the blood is pumped out from the ventricles
in the heart along with every heartbeat for J.M. The mentioned ejection fraction data is
completely based on the activity of the left ventricle functioning. The normal range for left
ventricle ejection fraction is 55% although J.M is having lower data reflecting that his heart
muscle is weakening due to hypertension (ambrosy et al., 2014).
Answer 11
The important things that are to be suggested to J.M are the reduction of stress level
thereby relaxing the responses of the sympathetic nervous system, he need to reduce his salt-
restricted diet for minimizing the fluid retention and to reduce the intake of fluid to 2L for
maintaining a balance. The pulse reading recorded to predict hypertension; he must avoid cold
and hot environment as both of them require cardiac activity and he must take his medicines
daily.
Answer 12
J.M needs a dietitian for helping him in providing medical nutrition and assisting low
sodium modification. He must control the intake of sodium to 2 to 3g and maximize the intake of
fluid to 2L.
Answer 13
b. Visual changes
c. Loss of appetite or nausea
e. Diarrhea

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HEART FAILURE AND CAD

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HEART FAILURE AND CAD
References
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Cannon, J. A., Moffitt, P., Perez-Moreno, A. C., Walters, M. R., Broomfield, N. M., McMurray,
J. J., & Quinn, T. a(2017). Cognitive impairment and heart failure: systematic review and
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Florea, V. G., & Cohn, J. N. (2014). The autonomic nervous system and heart
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in heart failure with preserved ejection fraction. Journal of the American College of
Cardiology, 63(25 Part A), 2817-2827.
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HEART FAILURE AND CAD
the Heart Failure Society of America. Journal of the American College of
Cardiology, 70(6), 776-803.