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    Adv Patho Case Presentation

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    The patient, an 88-year-old male, presented with shortness of breath, nausea, diarrhea and cough. He has a history of CHF, atrial fibrillation and other conditions. Exams and tests indicated CHF exacerbation likely due to recently stopping diuretic medication. CHF occurs when the heart cannot pump enough blood to meet the body's needs. It was classified as right-sided CHF and treated with diuretics, a low-salt diet, daily weight monitoring and referral to a CHF clinic.

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    Adv Patho Case Presentation

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    api-546259691
    87 views11 pages
    The patient, an 88-year-old male, presented with shortness of breath, nausea, diarrhea and cough. He has a history of CHF, atrial fibrillation and other conditions. Exams and tests indicated CHF exacerbation likely due to recently stopping diuretic medication. CHF occurs when the heart cannot pump enough blood to meet the body's needs. It was classified as right-sided CHF and treated with diuretics, a low-salt diet, daily weight monitoring and referral to a CHF clinic.

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    The patient, an 88-year-old male, presented with shortness of breath, nausea, diarrhea and cough. He has a history of CHF, atrial fibrillation and other conditions. Exams and tests indicated CHF exacerbation likely due to recently stopping diuretic medication. CHF occurs when the heart cannot pump enough blood to meet the body's needs. It was classified as right-sided CHF and treated with diuretics, a low-salt diet, daily weight monitoring and referral to a CHF clinic.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    87 views11 pages

    Adv Patho Case Presentation

    Uploaded by

    api-546259691
    The patient, an 88-year-old male, presented with shortness of breath, nausea, diarrhea and cough. He has a history of CHF, atrial fibrillation and other conditions. Exams and tests indicated CHF exacerbation likely due to recently stopping diuretic medication. CHF occurs when the heart cannot pump enough blood to meet the body's needs. It was classified as right-sided CHF and treated with diuretics, a low-salt diet, daily weight monitoring and referral to a CHF clinic.

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    ADVANCED

    PATHOPHYSIOLOGY
    CASE STUDY
    PRESENTATION
    Nikki Tacsik
    ■ A 88 year old Caucasian male presents to the ED with shortness of breath beginning 2 days
    ago. The complaint is persistent, moderate in severity, relieved by rest, and worsened by
    light exertion. Denies any chest pain or palpitations. Pt also complains of some nausea,
    diarrhea, and a mild cough. He denies any fever or chills.
    – Vitals in office: BP 108/68,HR 76, RR 16, temp 97.1*, no pain, O2 sat is 90% on RA

    ■ The patient has a past medical history of CHF, atrial fibrillation, carotid artery stenosis,
    CKD, glaucoma, hyperlipidemia, severe arthritis, and gout.

    ■ The patient has a past surgical history of a bilateral knee replacement (2011), left wrist
    fracture surgery, pilonidal cyst excision, and colonoscopy with biopsy.

    ■ The patient has a past social history of former smoking (about 40 years ago) and drinking
    alcohol socially. Family history includes heart attack in his father, and stroke in his mother

    ■ The patient has allergies to pravastatin and is up to date on all his immunizations.
    Diagnosis and Differential Diagnosis
    ■ The patient was originally being evaluated for pneumonia, but after further work up he
    is being evaluated for congestive heart failure exacerbation.
    – The patient had recently stopped his Lasix d/t worsening kidney function.
    – WBC count is normal, no temp, will check respiratory panel and follow WBC
    count
    – CXR shows cardiomegaly and mild pulmonary vascular congestion
    – Pt also has 2+ pitting edema BLE
    – Respiratory panel was negative
    – BNP was 56,414
    CHF
    – Condition in which the body’s heart is unable to pump an adequate amount of blood
    to meet the body’s metabolic needs
    ■ 4 classifications
    – Systolic
    ■ Decreased cardiac output d/t decreased contractility
    – EF < 40%
    – Diastolic
    ■ Decreased ventricular filling
    – Left sided
    ■ Ineffective left ventricle contraction that causes blood to back up in the pulmonary
    circulation
    – Right sided
    ■ Ineffective right ventricle contraction that causes blood to back up in the peripheral system
    Causes of CHF

    Left sided Right sided Both


    ■ Left ventricle infarction ■ Left sided heart failure ■ Coronary Artery Disease
    ■ Aortic valve stenosis ■ Right ventricle infarction ■ Hypertension
    ■ Hypertension ■ Pulmonary valve stenosis ■ Arrhythmia
    ■ Hyperthyroidism ■ Pulmonary disease ■ Damaged Heart Valves
    ■ Congenital Heart Defects
    ■ Other Conditions
    (Diabetes, HIV, Thyroid
    Disease)
    Signs & Symptoms of CHF
    Left sided Right sided
    ■ Pulmonary congestion ■ *Edema

    ■ Dyspnea ■ *Weight gain


    ■ *Fatigue
    ■ Activity intolerance
    ■ Weakness
    ■ Fatigue
    ■ *Dyspnea
    ■ Weakness ■ *Exercise intolerance
    ■ Cold intolerance ■ Cold intolerance
    ■ Compensation s/s ■ Compensation s/s
    – Tachycardia, pallor, polycythemia, – Tachycardia, pallor, polycythemia,
    daytime oliguria daytime oliguria
    ■ Back up effects
    ■ Back up effects
    – Dependent edema, hepatomegaly,
    – Orthopnea, SOB. PND, splenomegaly, ascites, distended neck
    hemoptysis, rales veins, headache, flushed face
    Right Sided Heart Failure
    Pathophysiology
    1. Right ventricle weakens and cannot empty
    1. Most often a result of LV heart failure, blood backs up in pulmonary system, then
    eventually causes increased resistance to right ventricular emptying
    2. Decreased cardiac output to system
    3. Decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion
    4. Right ventricle will hypertrophy to compensate
    5. Back up of blood into systemic vein (vena cava)
    6. Increased venous pressure results in edema in legs and liver and abdominal organs
    7. Very high venous pressure causes distended neck veins and cerebral edema
    Diagnostic Testing
    ■ H&P
    – Weight gain
    ■ CXR
    ■ ABGs
    ■ Echocardiogram
    ■ EKG
    ■ BNP > 100
    Plan & Follow Up
    ■ The patient was…
    – placed on an ACE inhibitor to stop the renin angiotensin compensatory mechanism
    and also a diuretic to remove the excess fluid
    – instructed to limit his salt intake in his diet
    – instructed to record his daily weight first thing in the morning
    – given a referral to the CHF clinic in town for group meetings
    – scheduled for a follow up appointment in 2 weeks
    Sources

    ■ Huether, S. E. and McCance, K. L. (2019) Pathophysiology. St. Louis, MI: Elsevier.


    ■ Story, L. (2012) Pathophysiology: A Practical Approach. Sudbury, MA: Jones & Bartlett
    Learning, LLC.

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