Congested Heart Failure Case Study Essay

narration Martha Wilmington, a 74-year-old woman with a account of rheumatic fever while in her twenties, presented to her physician with complaints of increase shortness of breath (dyspnea) upon exertion. She also noted that the typical swelling shes had in her ankles for long time has started to get worse oer 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 decreased appetite, some nausea and vomiting, and discomfort in the regenerate upper quadrant of the abdomen.On physical examination, Marthas jugular veins were noticeably distended. Auscultation of the tone revealed a low-pitched, rumbling systolic murmur, heard best over the unexpended upper sternal b set up. In addition, she had an extra, S3 heart sound.Using the internet, do any applicable searches to give a reasonable scientific report to the questions below. Understanding figure 20-13 in your textbook also may add some insight to these questions.You may find the following links useful to aid you answering these questionsCongested Heart Failure storyABC of Heart FailureWhat is causing this murmur? Perhaps on that point has been restricting of Marthas pulmonic semilunar valve which is located between the right ventricle and the pulmonary artery. The closing of this valve is heard best over the left upper sternal border. As stated above, this is where auscultation of the heart revealing a low-pitched, rumbling systolic murmur. A murmuring sound is heard imputable to the high resistance to course being manage through.2) What is causing her S3 heart sound? An S3 sound is an extra sound indicating abnormal crosscurrent pressure inside the heart, namely against the ventricle walls during diastole (relaxation). Blood seems to be stream too rapidly into the ventricles during diastole. She may reach ventricular walls that have rifle hardened and thus not relaxing as needed in order to fill with ease. As the blood quickly flows in, it leave alone hit the hardened walls, creating an extra sound. In congestive heart failure, 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 current symptoms? excuse. Rheumatic fever caused by Group A streptococci bacteria 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 dominate 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 will jog for damage in order to still function optimally. The right ventricle, in this case, will become stronger in order to push the same amo unt of blood (stroke volume) 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-colored (hepatomegaly) and a mode straddle 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, change magnitude hydrostatic pressure which increases fluid 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 wear support stockings. Why would this help her? Support stockings could be used. I motioned at a Med-Spa and the doctor would advise his patients to wear compression hoses after laser vein treatments if there were no other individual contraindications of use. Compression hoses prevent fluid from accumulating in surrounding tissues and interstitial spaces by directing excess fluid into other blood vessels and the lymphatic system.8) Which term more accurately describes the strive placed upon Marthas heart increased 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 general term describing Marthas origin? Right-sided congestive heart failure is the general term for Marthas condition.10) H ow might Marthas body compensate for the above condition? Marthas sympathetic nervous system will begin to predominate, causing denseness 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 medication called digoxin. Why was she assumption this medication, and how does it work? Digitoxin (digitalis) increases the strength and length ventricular contraction which slows heart rate by trim down sympathetic activity. Her right ventricle will then pump more efficiently.12) 12. Two weeks after starting digoxin, Martha returns to the physicians o ffice for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is importantly 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.