Hypertension/Heart Failure Discussion Essays. How would you classify her heart failure? What changes (modifications, additions, deletions) to her medications do you recommend that will: Improve her symptoms? Impact long term outcomes? What monitoring parameters do you recommend? What non-pharmacologic recommendations do you have?

Hypertension/Heart Failure Discussion Essays. How would you classify her heart failure? What changes (modifications, additions, deletions) to her medications do you recommend that will: Improve her symptoms? Impact long term outcomes? What monitoring parameters do you recommend? What non-pharmacologic recommendations do you have?

• How would you classify her heart failure?

  Our young lady is feeling tired and is experiencing shortness of breath while walking short distances. New York Heart Association would classify her as II and the American College of Cardiology/American heart Association would stage her at C due to cardiac disease that results in slight limitations of physical activity that results in fatigue and dyspnea.(Chisholm-burns et al., 2019)

  What changes (modifications, additions, deletions) to her medications do you recommend?

  According to 2017 ACC/AHA/HFSA guidelines I would discontinue her verapamil and HCTZ and start her on a loop diuretic  such as Furosemide 20 mg BID to control her edema and fluid overload and begin an ACE inhibitor such as Captopril 6.25 mg TID and titrate up as needed. (Heart Failure – American College of Cardiology, 2017) I may also consider adding a beta blocker due to her advanced stage of C. Once she maxes her dose of beta blockers, Ivabradine could be considered due to her EF of 30%, SR, and HR greater than 70. (Hajuli & Ludhwami, 2020)

  I would also discontinue her NSAIDS due to the  history of worsening CHF and kidney function. (Hajuli & Ludhwami, 2020) If after 3 months on her new therapy there is no improvement of her EF of 30% I would discuss the need for an ICD device. (Hajuli & Ludhwami, 2020) Hypertension/Heart Failure Discussion Essays

  What monitoring parameters do you recommend?

  I would monitor her blood pressure, electrolytes, BUN and creatine for the ACE addition, her BP, HR, and ECG for the  Beta blocker addition, and weight and kidney function witht he loop diuretic addition. (Chisholm-burns et al., 2019) Follow up of her ejection fraction in 3 months to see improvement with the new medicine regime would also be needed.

  What positive outcomes would you expect as a result of your recommendations?

  Hopefully with the proper medicine her EF would improve above 35%, her edema would be gone, and her symptoms with walking would be gone.

  What non-pharmocologic recommendations do you have?

  I would recommend a diet with sodium restriction of 2-3 grams per day, fluid restriction of 2 litres per day, daily weights, patient education on signs and symptoms and an aerobic exercise program. (Hajuli & Ludhwami, 2020)

   

  References

  Chisholm-burns, M. A., Schwinghammer, T. L., Malone, P. M., Kolesar, J. M., Lee, K. C., & Bookstaver, P. B. (2019). In Pharmacotherapy principles and practice, fifth edition (5th ed., p. 80). Mcgraw-hill Education / Medical.

  Hajuli, S., & Ludhwami, D. (2020). Heart failure and ejection fraction – statpearls – ncbi bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553115/

  Heart failure – american college of cardiology. (2017). American College of Cardiology. https://www.acc.org/education-and-meetings/products-and-resources/guideline-education/heart-failure Hypertension/Heart Failure Discussion Essays.