STUDY OF ILLNESS CONDITION

ASSESSMENT ORGAN INVOLVED NORMAL FUNCTION PATHOPHYSIOLOGY ANALYSIS

The cardiovascular system can be Congestive heart failure is a syndrome LABORATORY TEST
Subjective Cues: HEART thought of as the transport system that can be caused by a variety of  Blood Test for Natriuretic Peptides
of the body. This system has three
 Patient Verbalized Complaints of abnormalities, including pressure and BNP and NT-proBNP are elevated
main components: the heart, the
Persistent abdominal discomfort, volume overload, loss of muscle, in response to changes in pressure
blood vessel and the blood itself.
heartburn, difficulty swallowing, The heart is the system’s pump and primary muscle disease or excessive inside the heart related to patients
persistent cough, mild substernal the blood vessels are like the peripheral demands such as high output with Heart Failure.
chest pressure and increase delivery routes. Blood can be failure.  Creatinine 1.6mg/dL - high levels are
bilateral legs swelling and mild thought of as a fluid which contains In the usual form of heart failure, the markers of poor cardiac output as in
substernal chest pressure the oxygen and nutrients the body heart muscle has reduced contractility. patient’s with CHF . Normal
needs and carries the wastes which
(+) History of Hypertension This produces a reduction in cardiac creatinine in the blood is 0.84 to 1.21
need to be removed.
(+) History of Diabetes output, which then becomes inadequate mg/dL. Patient has high blood
The heart to meet the peripheral demands of the volume causing pressure build up in
Objective cues: body. the main vein connected to the
The heart is a muscular organ The heart of a person with heart failure kidney, leading to the congestion of
Weak, Fatigue roughly the size of a closed fist. It may have a reduced force of contraction the blood in the kidney. In CHF blood
Cough persistently due to overloading of the ventricle. In a and fluids are not properly being
sits in the chest, slightly to the left
Tachypneic (RR= 26 breaths/min) healthy heart, increased filling of the distributed to the body
Bilateral leg swelling of center. As the heart contracts, it ventricle results in increased contraction  BUN- 33mg/dL - High indicating that
pumps blood around the body. It force (by the Frank–Starling law of the the kidneys are less able to clear urea
Vital Signs: heart) and thus a rise in cardiac output. from the bloodstream in condition
carries deoxygenated blood to the
BP= 210/100mmHg In heart failure, this mechanism fails, as wherein renal perfusion is decrease
RR= 26 breaths/min lungs where it loads up with the ventricle is loaded with blood to the such as CHF.In general normal BUN =
oxygen and unloads carbon point where heart muscle contraction 7 to 20mg/dL.
becomes less efficient. This is due to
dioxide, a waste product of
reduced ability to cross-link actin and
metabolism. myosin filaments in over-stretched heart
muscle. A reduced stroke volume may
 occur as a result of a failure of systole,
diastole or both. As the heart works Diagnostic Evaluation:
Lab Results: harder to meet normal metabolic  CXR - Characteristics findings are
BUN=33mg/dL demands, the amount cardiac output Cardio- to thoracic width ratio above
Creatinine= 1.6mg/dL can increase in times of increased 50%, cephalization of the pulmonary
Total Bilirubin= 1.9gm/dL oxygen demand (e.g., exercise) is vessels. Kerleys B-lines and pleural
Direct Bilirubin= 0.3mg/dL reduced. This contributes to the exercise effusions.
Total Protein= 5.8g/dL intolerance commonly seen in heart  ECG - Electrocardiogram is important
Albumin=3.1g/dL failure. This translates to the loss of in identifying CHF main arrhythmias
Sodium=132mEq/L one's cardiac reserve, or the ability of Atrial Fibrillation, Ventricular
Chloride= 93mEq/L the heart to work harder during Tachycardia and Ventricular
Potassium= 4.0mEq/L strenuous physical activity. Since the fibrillation also of acute evidences
Bicarbonate =23mEq/L heart has to work harder to meet the prior myocardial infarction or acute
Increase BNP and NT- proBNP levels normal metabolic demands, it is ischemia.
Urine Specific Gravity= 1.032 incapable of meeting the metabolic  Echocardiogram - The test can
Urine protein= 1 plus protein demands of the body during exercise. visualize the size and shape of the
(+) hyaline casts. heart. It measures ejection fraction,
an important measurement of how
well the the heart is pumping. The
normal ejection fraction of a health
heart is 55%. In CHF, ejection fraction
is less that 40%.

Therapeutic Management and

Pharmacologic interventions

✓ Medical care for heart failure

includes a number of
nonpharmacologic, pharmacologic,
and invasive strategies to limit and
reverse its manifestations.
Depending on the severity of the
illness. For this patient in this
scenario;
✓ nonpharmacologic therapies include
 dietary sodium and fluid restriction;
physical activity as appropriate; and
attention to weight gain.
✓ The goals of pharmacotherapy for
heart failure are to reduce morbidity
and to prevent complications. Along
with oxygen, medications assisting
with symptom relief include:
✓ (1) diuretics, which reduce edema by
reduction of blood volume and
venous pressures. Injection Lasix
80mg IV x OD
✓ (2) beta-blockers, for neurohormonal
modification, left ventricular ejection
fraction (LVEF) improvement,
arrhythmia prevention, and
ventricular rate control. Tab
Metoprolol 12.5 mg X OD
References: https://healthengine.com.au/info/cardiovascular-system-heart

https://emedicine.medscape.com/article/163062-overview