Heart Failure
Carol is a 68-year-old African-American female who went to her doctors office because of a “racing heart”. She has been experiencing a worsening of shortness of breath over the last 2 months. Over the last 3 weeks, she noticed swelling of her ankles and feet. Carol states that she feels weak and tired most of the time. She has been awakened in the middle of the night with severe shortness of breath despite sleeping on 3 pillows.
Carols past medical history includes: a myocardial infarction several years ago, high cholesterol, gastroesophageal reflux, and osteoarthritis. She has allergies to nuts, shellfish, and strawberries.
Carol has a family history of atherosclerosis, myocardial infarction, and stroke.
Carol has been a 2-pack-per-day cigarette smoker for 30 years. She has been trying to quit smoking since her heart attack. Carol states she occasionally drinks alcohol.
Physical Examination:
Blood pressure: 163/94
Heart rate: 125 beats per minute and regular
Respiratory rate: 28 breaths per minute and labored
Temperature: 98.6 F
Height: 58”
Weight: 215 lbs.
Skin: is pale with cool hands and feet.
Positive jugular vein distention
Lungs: bibasilar rales (crackles) on auscultation
Abdomen: hepatomegaly (enlarged liver)
Extremities: bilateral pitting edema of lower extremities
Labs:
B-type Natriuretic Peptide (BNP) – 885 pg/mL (normal=100 pg/mL)
QUESTIONS:
1. Explain the pathophysiology of left-sided heart failure and right-sided heart failure.
2. In a chart, please compare and contrast the signs and symptoms of left-sided and right-sided heart failure.
3. Based on the information given in this case study, what type of heart failure do you
suspect that Carol has developed?
a. Identify specific data from the case study that supports your answer.
b. Explain the pathophysiology for the data you identified in 3a. Be sure to cite your references.
4. What is the probable cause of the heart failure?
5. Identify 4 risk factors that probably contributed to Carols past heart attack. Please
indicate if each risk factor is modifiable or not.
a. How does Carols blood pressure affect her current health status?
b. Why is Carol tachycardic?
c. Why is Carol tachypneic?
d. Based on her BMI, what can you say about Carols weight?
