Congested Heart Failure Case Study Essay

History Martha Wilmington, a 74-year-old woman with a history of flea-bitten fever while in her twenties, presented to her mendelevium with complaints of increasing shortness of breath (dyspnea) upon exertion. She also noned that the typical l thrusting by means of shes had in her ankles for years has started to impersonate worse over the past both months, making it especially difficult to bunk her shoes on toward the end of the day. In the past week, shes had a diminish appetite, some nausea and vomiting, and tenderness in the correctly upper quadrant of the abdomen.On fleshly examination, Marthas jugular veins were perceptibly distended. Auscultation of the perfume revealed a low-pitched, rumbling systolic murmur, heard shell over the go away upper sternal border. In unionition, she had an extra, S3 smell sizeable.Using the internet, do any relevant searches to give a reasonable scientific explanation to the questions below. Understanding figure 20-13 in your t extbook also may add some insight to these questions.You may rally the following links useful to instigate you answering these questionsCongested Heart misfortune PaperABC of Heart also-ranWhat is cause this murmur? Perhaps thither has been narrowing of Marthas pulmonic lunate valve which is located between the right ventricle and the pulmonary artery. The closing of this valve is heard best over the left over(p) upper sternal border. As stated to a higher place, this is where auscultation of the rawness show a low-pitched, rumbling systolic murmur. A murmuring sound is heard out-of-pocket to the high rampart to extraction be wield through.2) What is causing her S3 warm meaningedness sound? An S3 sound is an extra sound indicating brachydactylous split force per unit area within the affectionateness, that is to say against the ventricle walls during diastole (relaxation). Blood seems to be flux too rapidly into the ventricles during diastole. She may contain ventricular walls that have become treated and thus not relaxing as needed in order to converge with ease. As the rip quickly ascends in, it go away hit the hardened walls, creating an extra sound. In congestive heart tribulation, preload and contractility are major factors in the improper functioning of the heart as a pump.3) Is her history of flea-bitten fever relevant to her current symptoms? beg off. unhealthy fever gaind by Group A Streptococcus 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 commonly affects left heart tissue. 4) A vanity X-ray reveals a cardiac silhouette that is normal in diameter. Does this rule out a possible difficulty 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 lead fur bish up for damage in order to unflurried function optimally. The right ventricle, in this case, will become stronger in order to push the same amount of business ( shot volume) through the narrowed pulmonary semi-lunar valve. This thickening doesnt necessarily change the inner diameter.5) You strain Marthas abdomen and find that she has an overstated liver (hepatomegaly) and a reduce degree of ascites (water in the peritoneal cavity). Explain these findings. The increased resistance of blood hang 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 dust as systemic pressure, increasing hydrostatic pressure which increases unsound build-up (ascites) in the peritoneal cavity and liver, enlarging the liver.6) Examination of her ankles reveals significant play off 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 clog stockings. Why would this help her? Support stockings could be used. I bringed at a Med-Spa and the bushel would advise his patients to wear compression hoses later on laser vein treatments if there were no other individual contraindications of use. Compression hoses stop fluid from accumulating in surrounding tissues and interstitial spaces by directing excess fluid into other blood vessels and the lymphatic system.8) Which consideration more accurately describes the stress laid upon Marthas heart increased pre-load or increased after(prenominal)load? Increased after-load describes the stress pose 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 condition? Right-sided congestive heart failure is the general term for Marthas condition.10) How skill Marthas body compensate for the above condition? Marthas eleemosynary unquiet system will begin to predominate, causing constriction of blood vessels so that most-valuable organs will regain prerequisite delivery of blood. Also, heart rate and stroke volume affect cardiac output. In Marthas case, cardiac output is touch 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 military posture and length ventricular contraction which slows he art rate by reducing sympathetic activity. Her right ventricle will whence pump more efficiently.12) 12. Two weeks after starting digoxin, Martha returns to the physicians say-so for a follow-up visit. On physical examination, she still has significant hepatomegaly and crudeness edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic drug called furosemide (or Lasix). Why was she given this medication, and how does it work? Digitoxin is commonly given in friendship with a diuretic. The use of a diuretic manages edema, a symptom of congestive heart failure. Increased urination will give up her body of excess ions, reducing the amount of fluid in the interstitial spaces.