Question

MM is a 80-year-old female who has been hospitalized for acute heart failure. She has been living independently in her apartment. She has a history of hypertension, asthma and obesity and had a myocardial infarction last spring. Over the past summer, she noticed increased periods of shortness of breath with activity. She has also noted a 10 pound weight gain over the past two week period with a cough productive of thin frothy sputum. She was seen in the clinic and admitted to the hospital in order to manage her heart failure. Objective Data: Neurologic: alert and oriented • Cardiovascular: blood pressure 104/60, heart rate 120 • Pulmonary: respiration 28 per minute and labored • Extremities: 2+ pitting edema in feet and ankles extending bilaterally to mid-calf region Critical Thinking Questions: 1. What clinical manifestations is MM experiencing and what is the mechanism causing each of these? 2. Identify one of her risk factors that could be responsible for current symptoms and explain how this contributes to heart failure 3. Discuss what you would suspect her hemodynamic parameters (preload, afterload, contractility and cardiac output) are and why are they normal, increased or decreased.

Answer 1

326 o Ireload is the volume of blood an ventrice at the end of diastole Afterleed is the pressure of resistono the ventricles must contract against or overcome to eject the blood on • Contractability is the intrinsic ability of heart to contract independent of preload & afterload. • Calciar autput is product of stroke volume 4 heart beat heloof iniseases as well as ofterlof Contractibility decreases in heart Hereby increasing both - Cardion sulgut also decreases in CamScannetaal

1. Clinical Manifestations i •Shortness of breath with activity weight gain productie cough et pitting odene in feet & ankles Acute heart failure is Sudden inbility of the heart to pure blood to the body there is backup of blood in lungs causing Startness of breath and productive coughs Due to podig of blood in lower eptirenita increased Sydrostatic pressure fores fluid into extracelluler space & causes putting edema a onerell Scanned with Es Camscaweight gain .

s Ruhe factors: Hypertension age of soya, obesity Myocardial infarction are resk factors associated with heart As advaning are obesity increases the risk of developing lypertension Hyper tesion causes acrowing of blood vessels leeding to coronary artery duese It caused failure of heart to pump blood because of insufficient myocardial perfusion. Similarly mypoldid infarction damages myocardium eu therefore heart becomes unable to pure blood & therefore anireases cs the push of heart failure Scarlett Cam Scanner