Case scenario: A.O. is a 70-year-old woman with a 5 year history of congestive h
ID: 3505417 • Letter: C
Question
Case scenario: A.O. is a 70-year-old woman with a 5 year history of congestive heart failure (CHF) secondary to a large left ventricular infarct. She has had increasingly poor activity tolerance and now requires assistance with activities of daily living. Even minimal activity is associated with moderately severe dyspnea and exertional chest pain, which is relieved by rest. A.O. has also recently exhibited marked pedal edema bilaterally. She takes digitalis, furosemide (Lasix) and sublingual nitroglycerin. She is currently hospitalized for evaluation and management of worsening in her CHF. Which type of heart failure (left or right sided) is usually associated with the clinical manifestation of dyspnea? What other clinical findings are likely to be present with this type of heart failure and what is the mechanism behind their development? This patient now has pedal edema, what do you think is the most likely cause of A.O’s pedal edema? Pick two of the medications the patient is on and describe the (physiologic) rationale for the use of that medication in managing her heart disease. Include in your answer what component of cardiac output the medication impacts and how.
Explanation / Answer
Medication in managing her heart disease
SUBLINGUAL NITROGLYCERIN: nitrate that is used to dilate blood vessels by relaxing the smooth muscles that surround the vessel – especially veins and coronary arteries.
Positive inotropic: increase force and velocity of myocardial contractions to increase stroke volume.
Negative chronotropic: decrease heart rate
Negative dromotropic: decrease automaticity at SA node, AV node, and bundle of His.