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    Case Scenario CHF

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    chetankumarbhumireddy
    Mr. Chandra Sekhar, a 79-year-old male and retired metalworker, was admitted to the hospital for decompensated heart failure. He had a history of progressive shortness of breath and lower extremity swelling. Tests revealed his left ventricular ejection fraction was 26% and he was referred for cardiac treatment. On examination, he had signs of ascites, elevated blood pressure, and edema. Laboratory tests showed elevated BNP and signs of heart failure on chest X-ray. He was started on diuretics, aspirin, statin, and medications for hypertension and heart failure.

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    Case Scenario CHF

    Uploaded by

    chetankumarbhumireddy
    68 views2 pages
    Mr. Chandra Sekhar, a 79-year-old male and retired metalworker, was admitted to the hospital for decompensated heart failure. He had a history of progressive shortness of breath and lower extremity swelling. Tests revealed his left ventricular ejection fraction was 26% and he was referred for cardiac treatment. On examination, he had signs of ascites, elevated blood pressure, and edema. Laboratory tests showed elevated BNP and signs of heart failure on chest X-ray. He was started on diuretics, aspirin, statin, and medications for hypertension and heart failure.

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    Case scenario CHF

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    Mr. Chandra Sekhar, a 79-year-old male and retired metalworker, was admitted to the hospital for decompensated heart failure. He had a history of progressive shortness of breath and lower extremity swelling. Tests revealed his left ventricular ejection fraction was 26% and he was referred for cardiac treatment. On examination, he had signs of ascites, elevated blood pressure, and edema. Laboratory tests showed elevated BNP and signs of heart failure on chest X-ray. He was started on diuretics, aspirin, statin, and medications for hypertension and heart failure.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    68 views2 pages

    Case Scenario CHF

    Uploaded by

    chetankumarbhumireddy
    Mr. Chandra Sekhar, a 79-year-old male and retired metalworker, was admitted to the hospital for decompensated heart failure. He had a history of progressive shortness of breath and lower extremity swelling. Tests revealed his left ventricular ejection fraction was 26% and he was referred for cardiac treatment. On examination, he had signs of ascites, elevated blood pressure, and edema. Laboratory tests showed elevated BNP and signs of heart failure on chest X-ray. He was started on diuretics, aspirin, statin, and medications for hypertension and heart failure.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Mr.

    Chandra Sekhar, a 79-year-old male and retired metalworker, was admitted to the hospital on 8 th
    April 2020 at 8:45am due to decompensated heart failure.

    Mr. Chandra Sekhar was referred 1 year before with a history of progressive dyspnoea triggered by
    less than ordinary activities, lower-extremity edema, and abdominal enlargement. He sought medical
    care due to the abdominal enlargement, which was diagnosed as an ascites. He denied chest pain,
    hospitalization due to myocardial infarction or stroke, hypertension, dyslipidemia, and diabetes.

    Mr. Chandra Sekharwas a previous smoker and had stopped smoking at the age of 37 years. He was
    also an alcoholic and reported drinking alcohol for the last time 1 year before.

    He was referred to Cardiac centre for treatment of heart failure.

    An echocardiogram revealed an increased thickness in the septum (17 mm) and free left ventricular
    wall (15 mm), and a left ventricular ejection fraction of 26%.

    Mr. Chandra Sekharreported daily use of enalapril 10 mg, spironolactone 25 mg, furosemide 80 mg,
    omeprazole 40 mg, and ferrous sulfate (40 mg Fe) three tablets.

    On physical examination he showed a weight of 55 kg, height of 1.75 m, body mass index (BMI) of 18
    kg/m², heart rate of 110 bpm, blood pressure of 178/112 mm Hg, and the presence of a
    hepatojugular reflux. There were no signs of jugular venous hypertension, and the pulmonary and
    cardiac auscultations were normal. He had ascites, and his liver was palpable 5 cm below the right
    costal margin. Peripheral pulses were palpable, and a ++/4+ edema was observed.

    Observations
     temperature : 36.5 °C
     Pulse rate: 110bpm
     Pulse rhythm:  Irregular
     ECG rate 116
     ECG rhythm: A Fib
     Resp rate: 24 per minute, regular, shallow
     Resp quality: Bibasal consolidation & rales on auscultation
     SpO2% 89% @ room air
     Cap Refill <2secs
     BP 178/112
     Pupils PEARRL, size 4
     GCS 11/15 (E4, V2, M5)
     BGL 14.4.0mmol/l

     Laboratory results show a pro-B-type natriuretic peptide level of 1302 pg/mL, a troponin level of
    <0.34, and an unremarkable basic metabolic panel (BMP)
    CBC:
    Leukocyte count = 8,4000/mm3 with normal differential count
    Hemoglobin 14.6g/dL, Hematocrit 40%
    Platelet count 290,000/mm3
    Chest X-ray:
    "Marked prominence of the pulmonary vascular shadows (bilateral), bilateral pleural effusions,
    increased haziness and decreased radiolucency of the lung parachyma (bilateral), increased
    transverse diameter of the heart."
    Initial arterial blood gas analysis :
    pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90%
    Echocardiogram
    Ejection fraction appears to be in the range of 66% to 70%. The left ventricular cavity is borderline
    dilated.

    Treatment:
    1. Inj. Lasix 40mg .IV .BD
    2.Tab . Aspirin 150mg OD
    3.Tab. Simvastatin 40mg HS
    4. Tab. Ramipril 2.5mg OD
    5. Tab. Carvedilol .BD

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