First Peer Response: Please Respond To This Post ✓ Solved

First Peer Response Please Respond To This 2 Post And Not

Differentiate between systolic and diastolic heart failure. Heart failure is the heart’s inability to transport enough blood to meet the body’s demand at normal filling pressures, resulting in a complex and severe disease syndrome. Systolic heart failure is referred to as heart failure with reduced ejection fraction (HFrEF). This occurs when the heart’s ejection fraction pumps below 45%. HFrEF results from cell death due to lack of oxygen and nutrients as well as the build-up of metabolites from cell processes. Diastolic heart failure (HFpEF) occurs due to fibrosis and decreased ventricular compliance along with ventricular relaxation. Heart failure with preserved ejection fraction is pulmonary congestion in the presence of a normal stroke volume and normal cardiac output. The American Heart Association defines HFpEF as those individuals who have heart failure with an ejection fraction in the midrange of 40% but below 50%.

State whether the patient is in systolic or diastolic heart failure. The patient is in systolic heart failure (HFrEF) because of the echocardiogram showing an ejection fraction of 25%. Risk factors include hypertension and type 2 diabetes, alongside a new diagnosis of myocardial infarction (MI), which is a common cause of decreased contractility. Individuals with HFrEF will present with crackles, dyspnea, and S3 gallop.

Explain the pathophysiology associated with dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea. Due to the decrease in contractility from MI, an inflammatory response occurs with neurohumoral activation. This activation releases a cascade involving the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS). Kidneys retain sodium and water, which leads to increased preload. The combination of increased preload and impaired contraction diminishes blood supply, resulting in dyspnea on exertion, while peripheral edema arises from arginine vasopressin causing renal fluid retention. Jugular vein distention occurs from low blood pressure, which pushes the heart to pump harder, exacerbating symptoms of heart failure. Patients experience shortness of breath when lying down due to fluid returning to circulation.

Explain the significance of the presence of a 3rd heart sound and an ejection fraction of 25%. The 3rd heart sound, or ventricular gallop, occurs following S2 when blood rapidly flows from the atria into the left ventricle, which correlates with impaired myocardial contractility. A decreased ejection fraction signifies that the patient will likely be weak and fatigued due to inadequate oxygen perfusion, often presenting with limited activity tolerance.

Paper For Above Instructions

Understanding the differences between systolic heart failure (HFrEF) and diastolic heart failure (HFpEF) is crucial for accurate diagnosis and treatment. Heart failure is a progressive condition characterized by the heart's inability to adequately pump blood to meet the body's needs. Systolic heart failure, or HFrEF, is defined as an ejection fraction of less than 45%, indicating that the heart cannot contract effectively to expel blood during systole (McCance & Huether, 2019). On the other hand, diastolic heart failure (HFpEF) typically maintains a normal ejection fraction, but is characterized by impaired ventricular filling due to increased stiffness and decreased compliance of the heart muscle (Pfeffer et al., 2019).

The evaluation of patients with heart failure symptoms often includes an extensive workup to determine the underlying causes and correct classification of heart failure type. The clinical manifestations include dyspnea (shortness of breath), orthopnea (difficulty breathing while lying flat), pitting edema (swelling in the legs), and jugular vein distension, which all differ based on whether the heart failure is systolic or diastolic in nature (Zhang et al., 2017; Arrigo et al., 2020).

When diagnosing if a patient is experiencing HFrEF or HFpEF, healthcare providers look at the patient history, physical exam findings, and diagnostic tests such as echocardiography and EKGs. Symptoms that indicate HFrEF include an S3 heart sound, evidence of a reduced ejection fraction on echocardiogram, and signs of volume overload, like peripheral edema (McCance & Huether, 2019).

In the context of the patient in question, presented with an ejection fraction of 25%, it could be confirmed that the patient is experiencing systolic heart failure given this significant reduction. The risk factors of hypertension and type 2 diabetes further support the likelihood that decreased contractility and remodeling of the heart due to recurrent ischemia could have occurred (McCance & Huether, 2019).

Explaining the pathophysiology surrounding key symptoms is essential in comprehending heart failure's complex nature. Dyspnea on exertion occurs when the heart fails to effectively meet the body's demand for oxygen during physical activities, compounded by accumulated pulmonary congestion (Pfeffer et al., 2019). The neurohumoral activation during heart failure exacerbates the scenario; as blood flow is compromised, the body attempts to compensate through vasoconstriction and fluid retention, which can exacerbate congestion and lead to pitting edema (McCance & Huether, 2019).

Jugular vein distention generally reflects increased right atrial pressure due to backwards failure of the heart, and orthopnea is characterized by increased venous return when lying down, causing exacerbated symptoms of heart failure (Arrigo et al., 2020). The third heart sound (S3), or ventricular gallop, often signifies volume overload and can precede clinical decompensation in those with heart failure, indicating further need for aggressive management (Higgins, 2019).

In conclusion, differentiating between HFrEF and HFpEF is vital for patient management. Making an accurate diagnosis based on clinical evaluation, symptomatology, and ancillary testing allows healthcare providers to tailor interventions that are most appropriate for their patients. The significant reduction in ejection fraction alongside clinical findings of heart failure provides a framework for understanding the complexities of heart function and its management (Boehmer & Milton, 2019).

References

• Arrigo, M., Jessup, M., Mullens, W., Reza, N., Shah, A. M., Sliwa, K., & Mebazaa, A. (2020). Acute heart failure. Nature News.
• Boehmer, J., & Milton, S. (2019). Electronic S3 Prediction of Hospital Readmissions for HF Exacerbation. Case Medical Research.
• Higgins, J. P. (2019). Physical Examination of the cardiovascular system. International Journal of the Clinical Cardiology.
• McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biological basis for Diseases in adults and children (8th ed.). Elsevier Health Sciences.
• Pfeffer, M. A., Shah, A. M., & Borlaug, B. A. (2019). Heart Failure with Preserved Ejection Fraction In Perspective.
• Zhang, Y., Bauersachs, J., & Langer, H. F. (2017). Immune mechanisms in heart failure. European Society of Cardiology.
• Institute for Quality and Efficiency in Health Care. (2018). Types of Heart Failure.
• McMurray, J. J. V., & Pfeffer, M. A. (2019). Heart Failure. The Lancet.
• Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA Focused Guideline for the Management of Heart Failure. Journal of the American College of Cardiology.
• Drazner, M. H. (2011). The progression of heart failure. Circulation.