Congested Heart Failure Case Study Essay

History Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath (dyspnea) upon exertion. She also noted that the ordinary swelling shes had in her ankles for years has started to get worse all over the past two months, making it especially difficult to get her raiment on toward the end of the day. In the past week, shes had a rock-bottom appetite, some nausea and vomiting, and tenderness in the remediate focal ratio quadrant of the abdomen.On natural examination, Marthas jugular veins were noticeably distended. Auscultation of the soft centerfieldedness revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an trim, S3 fondness sound.Using the internet, do any relevant searches to give a reasonable scientific explanation to the questions below. Understanding ikon 20-13 in your textbook also m ay add some cleverness to these questions.You may sense the following links useful to aid you respond these questionsCongested Heart calamity PaperABC of Heart FailureWhat is causing this murmur? Perhaps there has been tapering off of Marthas pneumonic semilunar valve which is located between the right heart heart ventricle and the pulmonary artery. The apogee of this valve is heard best over the left upper sternal border. As stated supra, this is where auscultation of the heart revealing a low-pitched, rumbling systolic murmur. A murmuring sound is heard due to the utmost defense to origination being pumped through.2) What is causing her S3 heart sound? An S3 sound is an extra sound indicating abnormal course pressure within the heart, namely against the ventricle walls during diastole (relaxation). Blood seems to be flowing too rapidly into the ventricles during diastole. She may gift ventricular walls that have become hardened and thus not restful as needed in order to fill with ease. As the tune quickly flows in, it provide hit the hardened walls, creating an extra sound. In congestive heart ill, preload and contractility are major factors in the improper functioning of the heart as a pump.3) Is her history of rheumatic fever relevant to her flow symptoms? let off. Rheumatic fever caused by Group A Streptococcus bacterium may cause damage to heart tissues including valves. Overtime, congestive heart failure may have developed. However, the pulmonary semilunar valve seems to be the issue in this case study, whereas rheumatic fever normally affects left heart tissue. 4) A chest X-ray reveals a cardiac silhouette that is normal in diameter. Does this rule out a possible problem with Marthas heart? Explain. No, a normal diameter of a cardiac silhouette does not rule out a problem with Marthas heart. The heart adapts and leave alone compensate for damage in order to still function optimally. The right ventricle, in this case, will become str onger in order to push the same(p) amount of personal line of credit (stroke leger) through the narrowed pulmonary semi-lunar valve. This thickening doesnt necessarily change the inner diameter.5) You examine Marthas abdomen and find that she has an enlarged liver (hepatomegaly) and a moderate degree of ascites (water in the peritoneal cavity). Explain these findings. The change magnitude resistance of blood flow through the pulmonary semilunar valve from the right ventricle backs up the pressure of blood flowing into the right atrium. This back flow pressure builds up in the body as systemic pressure, increasing hydrostatic pressure which increases liquid build-up (ascites) in the peritoneal cavity and liver, enlarging the liver.6) Examination of her ankles reveals significant pitting edema. Explain this finding. Fluid builds up in the interstitial space of her extremities (i.e. ankles) due to the changes in the hydrostatic pressure caused by the back-flow pressure originating in the heart.7) She is advised to have a bun in the oven support stockings. why would this help her? Support stockings could be used. I worked at a Med-Spa and the doctor would advise his patients to wear compression hoses after optical maser vein treatments if there were no other individual contraindications of use. Compression hoses counter fluid from accumulating in surrounding tissues and interstitial spaces by directing plain fluid into other blood vessels and the lymphatic system.8) Which term more accurately describes the stress placed upon Marthas heart increase pre-load or increased afterload? Increased after-load describes the stress placed upon Marthas heart. Afterload is the pressure that the heart pumps blood against. There is increased pressure associated from left ventricular damage and narrowing of the semi-lunar valve in Marthas diseased state, leading to the resistance of blood flow.9) What is the cosmopolitan term describing Marthas condition? Right-sided co ngestive heart failure is the habitual term for Marthas condition.10) How might Marthas body compensate for the above condition? Marthas sympathetic nervous system will start to predominate, causing constriction of blood vessels so that important organs will regain necessary delivery of blood. Also, heart rate and stroke volume affect cardiac output. In Marthas case, cardiac output is affected due to a decrease in stroke volume. Higher resistance to blood flow decreases the amount of blood pumped by her ventricles, so the heart compensates in order to function optimally. Increased contractibility or the increased rate at which her heart pumps is indicative of this compensation.11) Martha is started on a medicinal drug called digoxin. Why was she given this medication, and how does it work? Digitoxin (digitalis) increases the strength and length ventricular densification which slows heart rate by cut down sympathetic activity. Her right ventricle will then pump more efficiently .12) 12. Two weeks after starting line digoxin, Martha returns to the physicians office for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic called furosemide (or Lasix). Why was she given this medication, and how does it work? Digitoxin is commonly given in conjunction with a diuretic. The use of a diuretic manages edema, a symptom of congestive heart failure. Increased urination will rid her body of excess ions, reducing the amount of fluid in the interstitial spaces.