Question

SCENERIO

Mrs. M is a 76-year-old Caucasian female who presented to the emergency department with extreme weakness, shortness of breath and increasing ankle edema which has progressively worsened over the last two weeks. Mrs. M has a history of myocardial infarction 8 years ago requiring stents. In addition, Mrs. M medical history is significant for HTN, DM Type II and Stage 4 Chronic Kidney Disease. Ms. M sees her primary care physician often for adjustments of her diuretics. She notes her last ECHO was done a year ago and was 48%. Upon initial evaluation in the ED the patient’s serum creatinine is 1.2, sodium 135 potassium 3.8, calcium 10.5, magnesium 2.3, hemoglobin 10.2 hematocrit 32% WBCs 6.5. On initial assessment Mrs. H’s vital signs were as follows BP 95/58, HR 78bpm, Resp 24/min, O2 Sat 95% on room air. An ECHO confirms an EF of 35%.

QUESTION:

Discuss the common causes of Heart Failure. What do you think were some possible contributing factors that led to Ms. M exacerbation of heart failure?

Answer 1

• The common causes of Heart Failure

Coronary artery disease- People with atherosclerosis(accumulation of fat in the arteries which supply cardiac muscle wall) have chance of occlusion of the coronary artery. It may leads to ischemia and hart failure.

Past history of cardiac problems- People with history of myocardial infarction, myocarditis etc has more chance to get heart failure.

Hypertension- People with high blood pressure have more chance of cardiac failure because the heart has to pump more forcefully to circulate the blood because the pressure inside the blood vessels is too high.

Heart valve disease and heart muscle diseases- valve abnormalities leads to poor pumping of blood from one chamber to another which makes pressure changes inside the heart and the cardiac muscle has more work load to pump the blood. It leads to cardiac dysfunction and heart failure. Dilated cardiomyopathy, hypertrophic cardiomyopathy or , myocarditis like cardiac muscle damage also contribute to cardiac failure.

Congenital heart disease- Birth defects in the heart alter the function of heart and leads to cardiac failure.

Severe lung disease- If the lungs are not working, the heart has to work overload to meet the circulatory needs which leads to cardiac muscle damage and failure.

Diabetes - Increased blood glucose eventually leads to increase blood lipid levels.It can cause atherosclerosis and hypertension which are leading cause of cardiac failure.

Anemia- In anemia, there is decrease in oxygen carrying capacity of blood to meet the tissue needs. It makes the heart to pump hard to pump more blood for adequate oxygen supply and leads to heart attack.

Life style habits- Alcoholism, obesity and smoking can change normal physiology of blood vessels by causing inflammation which contribute to heart diseases.

• Some possible contributing factors that led to Ms. M exacerbation of heart failure

1. Ms. M has history of myocardial infarction and stent therapy 8 years ago. So we can suspect a re- obstruction of stent which can leads to her present condition.

2.Ms. M has hypertension and diabetes mellitus. Theses are major leading factors for cardiac failure.

3. Ms. M has hemoglobin 10.2 (normal in women 12-15.5 gm/dl )which means she has mild anemia(Hb 10-12 gm/dl). This can also contribute to her condition as she has existing co-morbid risk factors of heart failure.

4. Ms. M has chronic kidney disease. In people with CKD, the kidneys may release more renin to control blood pressure. This can affect cardiac function and leads to heart failure.