Congestive heart failure is a severe progressive condition that affects the pumping power of the heart muscles. Because of decreased cardiac output the organs get inadequate blood, oxygen, and nutrients. CHF usually affects the lungs, heart, and kidneys(“Biomarkers in Heart Failure,” 2020). A decreased output causes kidney to retain water and salt. Because of the increased water retention, other organs get congested, leading to increase pressure on the heart. Causes of heart failure include Coronary artery disease, hypertension, alcohol abuse, valve disorders, and thyroid abnormalities.
In our case study our 50-year-old female arrives to the clinic to follow up on her heart failure. According to the NYHA class rating of heart failure our case study patient is in Class 2, and according to ACC/AHA stages she is in stage C heart failure. I am classifying her in this stage or class due to shortness of breath, fatigue, less ability to exercise, EF 30% so showing signs of heart failure damage.
In a review of her current medication regime, I would continue the hydrochlorothiazide, but I would increase her dose to 25 mg daily to increase its effect both as a diuretic and fore its effect on assisting in lowering the blood pressure. I would closely monitor this patient for hypokalemia and add a potassium supplement if needed. I would discontinue this patient’s verapamil SA 120 mg, a calcium channel blocker. Calcium channel blockers should be used in caution with those in heart failure as they can cause edema and decrease the hearts ability to pump blood(Heidenreich, 2016). I would choose to start this patient on an ACE inhibitor such as Lisinopril 5mg as a starting dose with the increased diuretic. Ace inhibitors are critical in the treatment of heart failure, they dilate the blood vessels to improve blood flow through the heart(“Ace Inhibitors,” 2018). Ace inhibitors also help block angiotensin, a substance in the blood that narrows vessels in the body. If this patient is not controlled with ACE inhibitors and diuretics, I would next ad a beta-blocker such as metoprolol. Beta blockers reduce mortality in chronic heart failure when used in conjunction with diuretics and ACE inhibitors. Ace inhibitors will decrease the work of the heart helping this patient to breath better and have more energy. The diuretic will help remove the extra fluid she retains and also take less stress off the heart, and decrease edema. With the new medications today, heart failure patients can live a long productive life, prolonging further heart damage. I would discontinue this patient Ibuprofen as NSAIDS have an increased risk of heart failure and can cause the body to retain more salt and water. I would recommend this patient non-pharmacological treatment for knee pain such as Ice, heat, and rest. This patient could try a topical arthritis medication such as Capzasin or solonpas. If she still needs relief through oral medication then I would suggest acetaminophen 1000mg every 6-8 hours. I would recommend this patient also make some life style modifications her BMI is on the overweight category, so recommending a low fat, low salt diet to improve health and promote weight loss would be beneficial to her health. As the medications start to work and this patient feels better, increasing exercise for weight loss and heart health is beneficial. If this patient is a smoker then I would council her on the benefit of smoking cessation on her health, this patient should avoid alcohol and licorice Hypertension/Heart Failure Discussion Essays. Licorice has been found to prompt potassium levels in the body to decline, which may lead to issues such as abnormal heart rate, high blood pressure, edema, and lethargy(Heidenreich, 2016).
Heart failure can now be treated successfully and offer patients a longer, higher quality life. Monitoring this patient for effectiveness of medications is important, as dosages can be increased and other medications added. This patient needs good cardiac rehab programs that support education and medication compliance. Good medical examinations including heart sounds, lung sounds, checking for increased edema, lab review and medication adjustments will be needed for the rest of this patient’s life. A referral to a cardiologist would also be recommended to help offer guidance when this patient’s heart failure progresses.
References
Ace inhibitors. (2018). Reactions Weekly, 1708(1), 14–15. https://doi.org/10.1007/s40278-018-48107-3
Biomarkers in heart failure. (2020). In Heart failure (pp. 276–289). CRC Press. https://doi.org/10.1201/b13888-17
Heidenreich, P. (2016). Heart failure patients need
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