University Report: Systolic Heart Failure Case Study of Mrs. Brown

This report presents a detailed analysis of a case study involving a 78-year-old female, Mrs. Brown, diagnosed with an acute exacerbation of chronic systolic heart failure. It explores the pathogenesis of the condition, linking it to heart dysfunction, irregular heart rhythm, and reduced cardiac output. The report delves into the compensatory mechanisms, including the sympathetic nervous system and the renin-angiotensin-aldosterone system, and discusses the impact of these systems on heart function. It outlines nursing strategies to manage symptoms such as shortness of breath and atrial fibrillation, including pharmacological interventions like Dabigatran, Rivaroxaban, and oxygen therapy. Furthermore, the report explains the mechanisms of action of IV furosemide (Lasix) and glyceryl trinitrate (GTN), detailing how these drugs help in managing heart failure by regulating fluid balance and heart muscle relaxation. References support the evidence-based practices discussed throughout the report.

Running head: SYSTOLIC HEART FAILURE
SYSTOLIC HEART FAILURE
Name of Student:
Name of University:
Author’s Note:

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Answer number 1.
Acute exacerbation of chronic heart failure is the clinical diagnosis for Mrs Brown. The
pathogenesis of the systolic heart failure is related with the dysfunction of heart which underlie
with disruption in transmission of signal and irregular heart rhythm. Heart failure happens when
there is inadequate pumping of blood which cause low cardiac output. Heart failure in patient is
because of damage of cardiac cells which is related to alcoholic cardiomyopathy and
degenerative valve disease. According to the study of Volpe, Carnovali and Mastromarino
(2016), it can be analyzed that heart failure mainly occur in elderly patient reported with
numerous comorbidities like lung disease, angina, hypertension, diabetes and high cholesterol.
In normal functioning of heart, the blood is transported to the heart through aorta and it is
transmitted to the rest of the body by the pulmonary veins and arteries. Heart failure happen
there is narrowing of arteries and veins due to accumulation of high cholesterol or other
indigestible materials. The blood is not able to be circulated with full efficiency and encounter
resistance in the flow. It lead to inefficient pumping of heart and low cardiac output. It is evident
from the case study of Mrs Brown that she was having issue with breathing, had dyspnea, high
blood pressure and low level of oxygen saturation. The sign and symptoms were relevant with
the heart failure. Hart failure cause difficulty in breathing because as the blood is not able to flow
with adequacy, oxygen is not reached to every cell and in lung which leads to dyspnea. However,
according to Asgar, Mack and Stone (2015) systolic heart failure is also connected to the
systematic response.
Concerning to pathophysiology, tow important term is needed to be considered. First,
preload which is the amount of blood entering into right ventricle chamber and afterload amount

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of blood which expelled from the left ventricle. Initiation of compensatory mechanism, leads to
high cardiac output. The two crucial mechanism are
sympathetic nervous system and
renin-
angiotensin aldosterone system. The two system gets stimulated when there is drop in blood
pressure. It causes activation of carotid baroreceptor of sympathetic nervous system which
causes elevation of the epinephrine and norepinephrine. These two hormones are the major
reason for the high contraction of the heart muscle, high afterload and high heart rate which also
leads to the peripheral constriction. The impact of it is deleterious as it causes decline of systole
of left ventricles and result in systolic heart failure. According to the law of Frank starling, due to
high contraction of ventricle, large amount of blood is filled in the heart. In case of heart failure,
there is low amount of blood entering into the heart and coming out of the heart due to less
contraction of the heart muscle. It is evident from the study of Harjola et al. (2017) that
contraction of heart muscle is low because of inefficient action of myosin and actin filament. As
the systole fails, the stroke volume gets declines.
Looking into the renin-angiotensin-aldosterone system, in account of high blood pressure,
there is low perfusion of blood and kidney undertake hypovolemia. As the result of it, there is
high level of sodium and water which simulates renin-angiotensin-aldosterone system. In
situation of vasoconstriction, the level of angiotensin which lead to high flow of blood and
causes adverse remodelling of the heart (Ter Maaten et al., 2015).
It is reported from the study of Stembridge et al. (2015) that systolic dysfunction implies
low stroke volume and incomplete emptying of the blood from the heart. The major reason being
the loss of the function of myocytes due to necrosis, loss of contractile protein, apoptosis and
essential ions. It also causes lack of transmission of the electrical impulse by disrupting the
function of SA node. The above discussion contribute to the systolic heart failure.

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Answer number 2.
The nursing strategy to manage the condition of Mrs Brown
First priority nursing strategy: To manage the issue of shortness of breath.
Acute heart failure is reported to show difficulty in breathing as oxygen is not able to
travel in whole body and also there is dysfunction of lungs Clark et al., 2016). Hence, the first
priority of care will bring the oxygen saturation level to 98%. The issue is also linked with the
fatigue and restlessness which is reported in case of Mrs Brown. The evidence based practice
regarding the issue is related to use of opioid and zodiazepine medication. Sanchis et al. (2016)
has done the systematic review which showed that these medicine is found to be effective
managing the breathing rate. Further, nurse can also give oxygen therapy to the patient which is
effective in increasing the oxygen saturation level. Cabello et al. (2016) has done study on
effectiveness on oxygen therapy, where he found that out of 200 patient, 187 patient have shown
improvement in breathing rate and function of lung after 7 hours of oxygen therapy. Moreover,
other evidence based practice is linked with administration of acupuncture with objective to
bring the patient in relax state. For bring this into action, nurses are required to assess the patient
for vital sign at regular interval of time.
Second priority nursing strategy: To make the heart rhythm of the patient normal.
There is the need to check and monitor the patient heart rhythm as she was reported with
atrial fibrillation. Carthon et al. (2015) has done study of various drugs which proves to be the
most beneficial in situation of the atrial fibrillation. The author has found that Dabigatran and
Rivaroxaban is two of the medicine which is known to give effective result. Hence, the strategy
would to giving pharmacological intervention by administering Dabigatran and Rivaroxaban

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drugs as they are antithrombotics. Other step would be to do electric cardioversion, in which
electrical shock is given to make the heart rate regular. The method. Polarize the cardiac cells
and prompt normal cardiac rhythm. Nurse are required to monitor the heart rate in regular time
period to check the function of the heart (Brown et al., 2019)
Answer number 3.
Working of IV furosemide (Lasix) –
The drug is effective in blocking reabsorption of water as it is a diuretic. In heart failure,
there is accumulation of water due to failure in function of kidney which also contribute to high
blood pressure. The drug is known to inhibit Na-K-Cl transporter protein which is known to be
situated in ascending loop of henle. This causes lowering of the sodium concentration in the
blood and maintain the blood pressure of the patient. It is known that, in situation of heart failure,
high heart rate can lead to lethal consequence. Therefore, there is the need effective medication
to treat the issue. Hence, Furosemide lower the concentration of sodium and decrease the
contraction and excitation of the heart (Felker et al., 2019)
Working of glyceryl trinitrate (GTN) –
The drug is known to be common vasodilator which relax the muscle of the heart and is
effective is regulating functioning of heart. The drug causes release of glyceryl trinitrate which
in turn sources nitric oxide and activate guanylate cyclase. The mechanism of action of glyceryl
trinitrate result in secretion of cGMP and also initiate the pathway of protein kinase located in
the heart muscles. Due to this pathway, there is dephosphorylating of the myosin protein and it
cause relaxation of cardiac muscle. As the impact of the drug, there is high flow of blood in the
heart and bring the heat rhythm to normal (Appleton, Sprigg & Bath, 2017).

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Reference
Appleton, J. P., Sprigg, N., & Bath, P. M. (2017). Therapeutic potential of transdermal glyceryl
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Asgar, A. W., Mack, M. J., & Stone, G. W. (2015). Secondary mitral regurgitation in heart
failure: pathophysiology, prognosis, and therapeutic considerations. Journal of the
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Felker, G. M., Borentain, M., Cleland, J. G., DeSouza, M. M., Kessler, P. D., O'Connor, C.
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