Question

2. Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula. (Learning Objective 1)

1. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities?

2. For what clinical manifestations should you assess to correlate to his left-sided heart failure?

3. How do his medications treat his congestive heart failure?

4. How does the hypokalemia affect the effects of Digitalis?

Answer 1

Answers:

a) Hypokalemia is the major side effect of Lasix. Patient has fatigue, generalized weakness and cardiac problems are mainly related to Hypokalemia.

b) In left sided heart failure, there is a back flow of blood to the pulmonary system due incomplete emptying of blood from left ventricles. It is characterized by dyspnea, cough, crackles during auscultation, decreased oxygen saturation, decreased cardiac output.

c) Digoxin slows the conduction through the AV node and increases the myocardial contractility and it results in increased left ventricular output . Lasix helps to reduce the preload and Coreg ( beta- blocker) helps to decrease the heart rate. Capoten (ACE inhibitor) ,it Increases the vasodilation and promote diuresis by decreasing preload and afterload.

d) Hypokalemia can leads to digitalis toxicity, which results in cardiac dysrhythmias.