Description
CASE STUDY SCENARIO
Luna Sorian is a 48-year-old woman with alcohol-induced cardiomyopathy. Her most recent left ventricular ejection fraction (LVEF) is 20%. Luna’s daily activities are limited by dyspnea and fatigue. Luna’s medications include:
Lisinopril 20 mg/day
Furosemide 40 mg twice daily
Carvedilol 12.5 mg twice daily
Spironolactone 25 mg/day
Digoxin 0.125 mg/day
Luna has been stable on these doses for the past month. Her most recent laboratory results include:
Sodium (Na) 140 mEq/L
Potassium (K) 4.0 mEq/L
Chloride 105 mEq/L
Bicarbonate 26 mEq/L
Blood urea nitrogen (BUN) 12 mg/dL
Serum creatinine (SCr) 0.8 mg/dL
Glucose 98 mg/dL
Calcium 9.0 mg/dL
Phosphorus 2.8 mg/dL
Magnesium 2.0 mEq/L
Digoxin 0.7 ng/mL
Luna’s vital signs today include blood pressure (BP) of 112/70 mm Hg and heart rate (HR) at 68 beats/minute (bpm). Her lung examination is clear.
ASSIGNMENT INSTRUCTIONS
After carefully reading the scenario, respond to the following two-part assignment:
Part A: Of the following options provided, explain which is the best approach for maximizing the management of Luna’s heart failure (HF), and why the others would not be an ideal therapeutic change at this time. Please use the HYMR lecture content and lecture slides, along with appropriate clinical guidelines for heart failure, and/or primary literature articles as needed to formulate your response.
Increase Carvedilol to 25 mg twice daily
Increase Lisinopril to 40 mg/day
Increase Spironolactone to 50 mg/day
Increase Digoxin to 0.25 mg/day
Part B: Luna’s therapy is optimized based on your recommendation for Part A. Her case illustrates an important distinction between medication selection and dosing for heart failure and other cardiac conditions. Explain the major differences when choosing and titrating doses in HF versus hypertension.
