Preparing The Assignment Requirements: Read The Case Study

Preparing The Assignmentrequirements1 Read The Case Study Below2 In

Read the case study about a 72-year-old male presenting with shortness of breath, leg swelling, fatigue, and signs consistent with heart failure. Examine the case details, including his history, physical exam, ECG, echocardiogram, and diagnosis. Address the following in your initial discussion post:

• Differentiate between systolic and diastolic heart failure.
• Determine whether this patient is in systolic or diastolic heart failure.
• Explain the pathophysiology associated with dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.
• Describe the significance of the presence of a third heart sound and an ejection fraction of 25%.

Support your response with at least one evidence-based reference. Additionally, engage in a minimum of two responses weekly to peers or faculty, on separate days, incorporating appropriate scholarly sources, with proper citations and references.

Paper For Above instruction

The presented case involves a 72-year-old male with clinical signs and diagnostic findings pointing toward congestive heart failure (CHF), which encompasses both systolic and diastolic dysfunctions. Differentiating between these two forms of heart failure is fundamental to understanding his condition and guiding treatment strategies.

Differences Between Systolic and Diastolic Heart Failure

Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), primarily involves impaired ventricular contraction, leading to decreased systolic function and reduced ejection fraction (EF). Typically, an EF less than 40% characterizes this subtype (Yancy et al., 2017). Contrarily, diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF), occurs when the ventricle's ability to relax and fill during diastole is compromised, but systolic function remains relatively intact, with EF usually above 50% (Nagueh et al., 2016). Both forms result in inadequate cardiac output but involve different pathophysiologic mechanisms.

Classification of the Patient’s Heart Failure

In this case, the patient has an ejection fraction of 25%, indicating significant systolic impairment. The decreased EF emphasizes that he is experiencing systolic heart failure (HFrEF). Additionally, the physical findings of pulmonary crackles, elevated jugular venous distention (JVD), lower blood pressure, and bilateral pitting edema align with this diagnosis. Therefore, the patient’s presentation is consistent with systolic heart failure.

Pathophysiology of Key Symptoms

Dyspnea on Exertion

Dyspnea during activity results from pulmonary congestion and edema due to increased pulmonary venous pressure caused by impaired left ventricular systolic function. The inability of the weakened heart to eject blood effectively causes blood to back up into the pulmonary circulation, raising hydrostatic pressure and leading to fluid leakage into the alveoli, which manifests as shortness of breath (Chioncel et al., 2016).

Pitting Edema

Pitting edema, especially in the lower extremities, develops secondary to increased venous pressure and fluid retention mediated by neurohormonal activation, notably the renin-angiotensin-aldosterone system (RAAS). Elevated venous pressures in congestive states cause fluid to shift into interstitial spaces, leading to swelling (McMurray et al., 2017).

Jugular Venous Distention

JVD indicates elevated right atrial and central venous pressures. It occurs due to right-sided heart failure, where the impaired right ventricle cannot effectively pump blood into the pulmonary circulation, leading to venous congestion. This is often associated with fluid overload and is a hallmark sign of the systemic effects of heart failure (Ponikowski et al., 2016).

Orthopnea

Orthopnea, or difficulty breathing when lying flat, stems from increased pulmonary venous pressure when supine, which exacerbates pulmonary congestion. Patients often find relief in sitting or sleeping in an elevated position, such as propping up with pillows or sleeping in a recliner, as seen in this patient (Yancy et al., 2017).

Significance of a Third Heart Sound and Ejection Fraction

The presence of a third heart sound (S3) is indicative of increased left ventricular filling pressures and volume overload. It is often associated with systolic heart failure due to rapid ventricular filling during early diastole when the ventricle is hypertensive or dilated. The S3 is an early marker of heart failure and correlates with increased morbidity (Katz, 2016). An ejection fraction of 25% confirms significant systolic dysfunction, reflecting severely reduced contractility of the myocardium. This low EF signifies poor systolic performance, increases the risk of hospitalization, and guides therapy aimed at improving cardiac output and managing symptoms (Yancy et al., 2017).

Conclusion

This case exemplifies systolic heart failure due to impaired myocardial contractility leading to reduced EF, pulmonary congestion, systemic venous congestion, and characteristic clinical signs such as JVD, edema, orthopnea, and an S3 heart sound. Understanding the pathophysiology underpinning these symptoms assists clinicians in diagnosis and management, which includes pharmacologic therapy targeting neurohormonal pathways to improve cardiac function and alleviate symptoms.

References

• Chioncel, O., Harjola, V. P., Mebazaa, A., et al. (2016). Epidemiology, pathophysiology, and management of acute and chronic heart failure. European Heart Journal, 37(27), 2189–2198.
• Katz, F. (2016). Heart sounds and rhythm abnormalities. In Fuster and Alexander’s Heart Disease: A Textbook of Cardiovascular Medicine (pp. 987–998). Wolters Kluwer.
• Mcmurray, J. J., et al. (2017). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure, 19(8), 891–975.
• Nagueh, S. F., et al. (2016). Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Journal of the American Society of Echocardiography, 29(4), 277–314.
• Ponikowski, P., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129–2200.
• Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Circulation, 136(6), e137–e161.