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) a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities? b. For what clinical manifestations should you assess to correlate to his left-sided heart failure? How do his medications treat his congestive heart failure? How does the hypokalemia affect the effects of Digitalis? c. d.

Answer 1

a) Digoxin is a cardiac glycoside used in management of heart failure. But it may cause serious adverse effects like generalised weakness and irregular heartbeat.

b) The above patient exhibits following symptoms that correlates to left side heart failure:

- decreased left ventricular function

- shortness of breath

- irregular heart rate

- fatigue and weakness

c) Digoxin : cardiac glycoside that affects the movement of sodium and potassium ions in and out of the cardiac muscles which helps to maintain the heartbeat and treat heart failure.

Capoten is a ACE inhibitor. It is used to treat hypertension and congestive heart failure. It promotes renal vasodilation and suppress renin angiotensin system

Coreg is a Nonselective beta-adrenergic and an alpha1-adrenergic blocking agent. It is used to treat high BP and CHF.

Lasix : it is a diuretic. It inhibits reabsorption of sodium and chloride ions at proximal and distal renal tubules and loop of Henle. It helps reduce edema associated with CHF, hypertension.

d) hypokalemia increase risk of digitalis toxicity.