Heart Failure

1.Indicate what type of heart failure this patient currently has. Discuss your rationale from patient’s history, physical exam and diagnostic testing results providing appropriate references.

The case patient has right-sided heart failure. The medical history of the patient shows that she had complained of having shortness of breath on walking for a period of six months. She also complained of being unable to sleep flat on the bed at night. Another symptom reported by the patient was the swelling in the feet and ankles. Besides, the patient experienced fatigue all time such that she could not perform activities of daily living. The symptoms depicted by the patient have been confirmed to result due to the right sided heart failure. For instance, the swelling in the feet and ankles results due to back up of fluid in the feet and ankles. Also, the shortness of breath is a clear symptom of right-sided heart failure which results when the patient lies down.

Apart from the subjective symptoms, objective data, including physical examination can be used to diagnose the type of heart failure.  Generally, patients with right-sided heart failure experience excessive weight gain which results due to the accumulation of excess fluids in the body (Konstam et al., 2018). In the case study, the patient was reported to have a body mass index (BMI) of 31 Kg/m2. Besides, her waist circumference was 98 cm. The measurements were above the normal ranges showing that the patient had gained weight, basically due to accumulation of fluids in the body. More so, the elevated blood pressure, pulse, and the distention of the jugular veins show that the patient is suffering from right-sided heart failure. Distention of jugular veins results due to the accumulation of pressure in the veins. Also, the displaced apex beat indicates a volume overload which results due to the inability of the heart pump blood. Furthermore, bibasilar crepitations heard on auscultation of her lungs show the accumulation of fluids in the lungs.

Moreover, different tests were performed on the patient, and they revealed signs of right-sided heart failure. Chest X-Ray showed cardiomegaly and pulmonary congestion which indicates accumulation of fluids in the lungs. On the other hand, EKG showed a delay in interventricular conduction which is caused by left ventricular hypertrophy.

  1. According to the NYHA functional classification of heart failure, what class of heart failure does the patient have and provide your rationale with appropriate references?

NYHA classification of heart diseases is a symptom-based classification of heart diseases whereby the disease is put into four categories depending on the severity of the presenting symptoms (Ponikowski et al., 2018). In this case, the patient can be classified into Class IV of heart disease since she cannot undertake any activity without discomfort. For example, she cannot take care of her husband who is suffering from colon cancer since she feels tired every time she tries to do simple tasks. Also, the patients show severe symptoms of diseases such as jugular vein distension, pitting edema, and pulmonary congestions. As well, she cannot sleep on the bed in a flat position unless shoe lays many pillows on it to keep his chest and head elevated. Such symptoms show that the patient is in a severe state and she needs close monitoring and treatment.

  1. Do you agree with the CHF discharge medications and why? If you don’t agree with the CHF discharge medications, choose what medications you would use to treat patient’s CHF and from what guideline you chose them from.

On discharge, the case-patient was given different medications which included; Furosemide 40 mg BID, Hydrochlorothiazide 50 mg QD, Bisoprolol 2.5 mg QD, Lisinopril 2.5 mg QD,  Metformin 1 gm QD,  Glimepiride 2mg mg BID, Simvastatin 40 mg QHS, Aspirin 75 mg QD, Slow K 40 mEq QD. According to me, the prescribed drugs are the right medications to manage congestive heart failure. Firstly, Furosemide is a loop diuretic which enhances the removal of excess water and salts from the body through kidneys. Thus, this drug was prescribed to manage pitting edema that was present in the patient’s feet and ankles. Hydrochlorothiazide, which is also a diuretic was also prescribed to perform a similar function as furosemide, and to lower high blood pressure. Based on the analysis of the patient’s symptoms, she was suffering from severe right-sided heart failure. As such, Bisoprolol, a selective beta-1 receptor blocker was prescribed to manage the severe form of the disease.

More so, Lisinopril, an ACE inhibitor was prescribed as a discharge drug as it could help the patient manage heart attack, high blood pressure, and prevent kidney damage from diabetes (Gordin,&Fonarow, 2016). According to medical history, the patient was suffering from other chronic diseases including `1diabetes and osteoarthritis. Such diseases also need to be managed since they contribute to the worsening of heart disease. Thus, metformin, a potent hypoglycemic agent was prescribed as a discharge drug so that the patient can take it as per the prescription to manage high blood sugars. Similarly, Glimepiride was prescribed for the purpose of managing blood sugar in the body. Furthermore, the patient’s blood test results showed an elevated amount of triglycerides and LDL in the body. Such fats are harmful to the body, and so they should be eliminated. Simvastatin was prescribed to lower such fats in the patient’s body so that she can return to good health. As shown before, the patient was suffering from osteoarthritis, a disease which s accompanied by joint pains. In this case, aspirin was prescribed to manage pain. Lastly, Slow-K is a drug taken orally to prevent hypokalemia which is common in diabetic patients.

To reduce the tendency of drug resistance, different classes of drugs were prescribed for the patient. For example, Furosemide was prescribed together with Hydrochlorothiazide so that they can help relieve the patient of excess fluids. Also, metformin was accompanied by Glimepiride to regulate blood sugars. Besides, the physician aimed at managing the patient symptomatically and so as to avoid erupting cases of diabetes or osteoarthritis that may worsen the patient’s condition.

  1. List ALL the potential drug interactions among ALL the drugs used to treat her Heart Failure, T2DM, and Hyperlipidemia using the “Drug Interaction Checker” found at the Drugs.com website. Provide a list of ALL the potential drug interactions and how you would make changes to her regimen in order to prevent any “Major” or “Moderate” drug interactions.
Drug Interaction
Furosemide Hydrochlorothiazide (Moderate)

Aspirin

Lisinopril

Hydrochlorothiazide Furosemide (Moderate)

Lisinopril

Metformin

Aspirin

Bisoprolol Hydrochlorothiazide

Aspirin

Lisinopril Aspirin (Major)

Metformin

Metformin Aspirin
Glimepiride Aspirin (Moderate)
Simvastatin Metformin
Aspirin Lisinopril (Major)
Slow-K Aspirin

Furosemide,

Hydrochlorothiazide,

Metformin,

Simvastatin

 

In the table above, drugs that interact with each other have been matched. As usual, the interaction between drugs affects their actions on the body either negatively or negatively. Therefore, interacting drugs should be identified to avoid their related effects. In the list of discharge drugs, most of the drugs interact with each other. Among them, there are major, moderate, and minor interactions. An example of major drug interaction is between Lisinopril and Aspirin. Taking a combination of the two may result in increased blood pressure. Since the case patient is already suffering from hypertension, the drugs should not be taken at the same time to avoid such risks. Therefore, one of the drugs should be excluded in the regimen.

Besides, there are moderate drug interactions which include the interactions between furosemide with hydrochlorothiazide and glimepiride with aspirin (Rosen et al., 2018). Also, moderately interacting drugs should be monitored closely before they are administered together. For instance, the interaction of glimepiride with aspirin increases the effects of glimepiride, and this may lead to an extreme decrease in body sugar. Thus, the combination should only be used under strict monitoring of the patient. Also, it is clear that aspirin interacts with almost every drug among the discharge medication. I could recommend that an alternative pain reliever drug be replaced instead of using aspirin which can result in many side effects.

Conclusion

Having analyzed the case study of heart failure, I have learned several things about the disease. Firstly, right-sided heart failure can result from different causes, and its risk factors include left-sided heart failure, diabetes, and hypertension. Also, heart failure can be classified using the NHYA classification system whereby they are rated based on the severity of the presenting symptoms. Also, health care providers should compare prescribed drugs before administering them so as to identify any drug interactions.

 

Reference

Gordin, J. S., &Fonarow, G. C. (2016). New medications for heart failure. Trends in cardiovascular medicine, 26(6), 485-492.

Konstam, M. A., Kiernan, M. S., Bernstein, D., Bozkurt, B., Jacob, M., Kapur, N. K., …&Raval, A. N. (2018). Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation, 137(20), e578-e622.

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.

Rosen, D., Anand, T., Esterlis, Y., Bidell, E., Bradbury, K., & Heller, J. (2018). U.S. Patent Application No. 10/026,137.

 

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