Description
Peer Responses:
Length: A minimum of 170 words per post, not including references
Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
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Diagnosis:
This patient is most likely to have congestive heart failure (CHF) when based on his history of current illness and physical examination. Assessment results revealed the following cues:
Short breath: In CHF, one is expected to experience shortness of breath or exertional dyspnea, especially when lying down and exercising, as found in this patient.
Cough, especially at night: Result of fluid accumulation in the lungs and pulmonary congestion in CHF.
Increased leg swelling: CHF is often characterized by bilateral lower extremity edema. The pitting edema is due to fluid retention and congestion.
Mild substernal chest pressure: It may be indicative of cardiac disease (Kishanrao, 2023).
Changes in vital signs
High blood pressure – 208/102mmHg. This puts the patient at risk for stroke and myocardial hypertrophy, which precedes heart failure (Bocchi & Ventura, 2022).
Tachycardia with a heart rate of 116. Due to cardiac workload on the heart and congestion within the ventricles. He also has hyperventilation with an oxygen saturation of 94%, which is a low normal side.
Differential diagnoses:
Pulmonary Edema: The patient’s symptoms of orthopnea, cough, and rales on auscultation are consistent with pulmonary edema.
Chronic Obstructive Pulmonary Disease (COPD) exacerbation: Chronic lung disease can present with similar symptoms, but acute worsening may indicate an exacerbation.
Renal Failure: Edema and hypertension are common complications of renal failure.
Therapeutic Plan Options:
Controlling the blood pressure is crucial to avoid any complications such as stroke, ischemia, or ventricular disease. Moreover, this patient needs to get rid of the fluid overload to allow the lung tissue to expand well and protect the lung tissue, allowing the lung to work correctly and avoid hypoxia and ischemia. Blood work for a patient with congestive heart failure (CHF) helps assess the severity of the condition, identify potential causes, and guide treatment. The most essential blood work for a patient with CHF includes:
B-type Natriuretic Peptide (BNP): These biomarkers are elevated in response to increased cardiac wall stress. Elevated levels support the diagnosis of heart failure and can help in assessing the severity.
Complete Blood Count (CBC): To assess for anemia, which can contribute to heart failure symptoms and worsen the prognosis.
Basic Metabolic Panel (BMP): To assess electrolyte imbalances, renal function (creatinine and blood urea nitrogen), and glucose levels.
Liver Function Tests (LFTs): Liver enzymes (AST, ALT) may be elevated in CHF, reflecting hepatic congestion and impaired perfusion.
Thyroid Function Tests (TFTs): Thyroid dysfunction can contribute to heart failure, and assessing thyroid function is crucial.
Lipid Profile: To evaluate lipid levels and guide the management of dyslipidemia, a common comorbidity in heart failure.
Coagulation Profile: Prothrombin time (PT) and activated partial thromboplastin time (aPTT) may be assessed to evaluate for coagulation abnormalities.
Troponin: Cardiac troponin levels may be checked to assess for acute myocardial infarction or myocardial injury.
Serum Albumin: Low serum albumin levels may indicate malnutrition and contribute to the overall patient’s nutritional status assessment.
Urinalysis: To assess for renal function and identify potential renal dysfunction.
These blood tests provide a comprehensive overview of the patient’s cardiac, renal, hepatic, metabolic, and hematologic status, helping clinicians tailor the treatment plan for CHF and address any underlying issues contributing to the condition. Regular monitoring of these parameters is essential for ongoing management and adjustments to the therapeutic plan (Conrad et al., 2019).
Medication or pharmacological options:
Oxygen therapy: Useful in maintaining oxygen saturation and alleviating respiratory distress.
Nitroglycerin: Helps relieve the acute chest pain associated with heart failure. It causes vasodilation, reducing preload on the heart and relieving chest pressure.
Diuretics (furosemide): Helps eliminate excess fluids and relieve symptoms associated with fluid overload.
Calcium channel blockers such as Verapamil, diltiazem, and amlodipine are common calcium channel blockers. Patients who are suffering from chest angina or myocardial infarction may benefit from calcium channel blockers.
ACE inhibitors or ARBs (Lisinopril): Increase cardiac function and reduce afterload. They also lower the high blood pressure to desirable levels.
Beta-blockers (e.g., metoprolol) lower blood pressure to desirable levels.
Lifestyle modifications: Reducing sodium intake, restricting fluid intake, and monitoring weight.
This patient must receive immediate treatment for acute symptoms and subsequent CHF management. It may also be necessary to refer the patient to a cardiologist for further evaluation and treatment (Heidenreich et al., 2022).
References
Bocchi, E. A., & Ventura, H. O. (2022). Systemic blood pressure in heart failure. JACC: Heart Failure, 10(6), 393-396. https://doi.org/10.1016/j.jchf.2022.02.017
Conrad, N., Judge, A., Canoy, D., Tran, J., O’Donnell, J., Nazarzadeh, M., Salimi-Khorshidi, G., Hobbs, F. D., Cleland, J. G., McMurray, J. J., & Rahimi, K. (2019). Diagnostic tests, drug prescriptions, and follow-up patterns after incident heart failure: A cohort study of 93,000 UK patients. PLOS Medicine, 16(5), e1002805. https://doi.org/10.1371/journal.pmed.1002805
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/Hfsa guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation, 145(18). https://doi.org/10.1161/cir.0000000000001063
Kishanrao, S. (2023). Congestive heart failure in Indian elders. Clinical Cardiovascular Research, 2(1), 01-04. https://doi.org/10.58489/2836-5917/006
