Systolic Ventricular Dysfunction Case Study

Symptoms of congestive heart failure consist of fatigue, dependent edema, fluid build-up in the lungs, increase in urination because of the extra fluid, nausea, vomiting, abdominal pain, and decreased appetite (Fundukian, 2011).  Diagnosis of CHF is done first by physical examination, such as heart rate, and heart sounds or murmurs. If a physician believes more tests are needed, common ones include an electrocardiogram or chest x-ray to detect previous heart attacks, arrhythmia, or heart enlargement, and echocardiogram using ultrasound to image the heart muscle, valves, and blood flow patterns. The physician may also want to do a heart catheterization, to allow the arteries of the heart to be visualized using angiography. Upon getting a diagnosis of CHF, the physician will usually start with asking the patient to change things in their diet, such going to a low sodium diet. They may also want to prescribe medications. Types of medications could include angiotensin converting enzyme (ACE) inhibitors, which block formation of angiotensin II hormone, angiotensin receptor blockers (ARB) to block the action of angiotensin II at the receptor site, and diuretics, just to name a few (Fundukian, 2011).

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

The heart is an organ that pumps oxygenated blood to the body and deoxygenated blood to the lungs. Heart failure is when the heart can’t pump blood very well. If the heart fails to work properly, a major system called the circulatory system won’t work properly and therefore the whole human body will fail to work properly because the cells won’t be able get oxygenated blood and use the oxygen to undergo cellular respiration and make energy.

Congestive heart failure patients may need multiple medications. Each medication option treats a different symptom or contributing factor and comes

Beta-blockers have been recently reported to decrease mortality in heart failure patients. Mortality and hospitalization rates for patients with the disease are high and continue to rise. Despite the magnitude of the problem, treatment of congestive heart failure is often inadequate. Primary care physicians care for most patients with heart failure. Beta-blocker therapy is appropriate in patients with NYHA class II or class III symptoms resulting from left ventricular systolic dysfunction. Unless contraindicated, beta-blockers should be considered a mainstay of therapy in these patients to improve symptoms and mortality and to decrease hospitalizations. Beta-blockers should not be administered to patients with heart failure who have bradycardia, heart block or hemodynamic instability.

For years health care providers have been using drugs like beta blockers or ACE inhibitors to treat patients with heart failure, but with cardiovascular disease still being a leading cause of death, it is evident that current treatments have been lacking the ability to produce adequate results. However, with the newest heart failure drug on the market a positive change has finally come for heart failure patients. The new heart failure drug reigns far more superior when compared to the treatments healthcare professionals already use and can potentially alter the foundation of heart failure treatments altogether.

Other hemodynamic effects have also been reported with usage of ivabradine. In a study by Kurtoglu et al, ivabradine was seen to improve heart rate variability in non-ischemic patients with heart failure. (26). De Luca et al showed that addition of ivabradine to optimal medical therapy in patients with stable heart failure with preserved ejection fraction with New York Heart Association (NYHA) class II, left ventricular ejection fraction (LVEF) > 50% and heart rate > 70 bpm, significantly improved physical performance by increasing exercise capacity (27). Another study in patients with stable ischemic heart failure, NYHA functional class II and LVEF ≤ 40%, confirmed these findings and additionally showed an improved gas exchange (with improvement

All hypertensive drugs lower blood pressure. However, they’re many forms of the drug, all with differing mechanisms of action. Hypertension refers to the constant lingering of blood pressure above the taken normal range of 120/80 mm Hg. Without the proper treatment, hypertension can lead to extreme difficulties such as kidney failure, coronary heart disease or a stroke. Angiotensin converting enzyme (ACE) inhibitors is an antihypertensive drug, which is among the most widely prescribed drug for lowering blood pressure in the United States (Friedman 2004). Angiotensin causes the narrowing of arteries, predominantly in the kidneys. ACE inhibitors assist in producing less angiotensin throughout the body, subjecting the blood vessels to vasodilation,

A ventricular septal defect (VSD) is a defect due to an abnormal connection between the lower chambers of the heart. A heart has four chambers. There are left and right upper chambers, which are called an atrium, and left and right lower chambers, called a ventricle. The ventricular septal defect is a hole that occurs between the left and right pumping chambers of the heart.

Pitt B, Pfeffer MA, Assmann SF et al (TOPCAT investigators). Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014 Apr 10;370(15):1383-92.

Lisinopril and levofloxacin were prescribed for Mr. P. Lisinopril was prescribed to treat Mr. P’s new found hypertension. Lisinopril is considered an angiotensin converting enzyme inhibitor (ACE inhibitor). ACE inhibitors are designed to block the vasoconstrictive properties by angiotensin II (Gutierrez, 2008, p712). By blocking this action, and dilating the arteries, the increased workload of the heart is once again decreased, causing decreased blood pressures again (Gutierrez, 2008, p712). ACE inhibitors also help the kidneys excrete sodium and water, thus decreasing the blood volume and decreasing the workload of the heart (Gutierrez, 2008, p712). ACE inhibitors “are biotransformed in the liver” (Gutierrez, 2008, p713, para 5). Excretion occurs through the urine and stool (Gutierrez, 2008, p713).

Angiotensin- Converting Enzyme Inhibitors also known as ACE inhibitors that are commonly used to decrease blood pressure. ACE inhibitors block the production of angiotensin I to angiotensin II which then decrease the levels of angiotensin II and elevated levels of bradykinin. ACE drugs are also used to treat heart failure, diabetic nephropathy, and MI. The blockage of angiotensin I to angiotensin II can produce vasodilation, decrease blood volume, decrease cardiac and vascular remodeling, potassium retention and fetal injury which are all possible side effects for ACE. A big thing to note about ACE it that it should not be given to women who are of childbearing age due to the risk for fetal injury, especially if they are in their second or third trimester of pregnancy. Since ACE inhibitors can increase bradykinin levels they potential side effect for that is vasodilation, ACE cough, angioedema. If a patient presents with signs of edema in their eyes, tongue and lips this could be sign of angioedema which is life threatening and patients should be sent to the hospital and not take ACE inhibitors anymore.

Lisinopril (Prinivil) is an oral medication of the angiotensin-converting enzyme (ACE) inhibitor class used to treat hypertension, congestive heart failure, and heart attacks. The mechanism of lisinopril in hypertension and heart failure results from inhibition of ACE, a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II, which results in decreased plasma angiotensin II which leads to decreased vasopressor activity and to decreased aldosterone secretion. Side effects may include blurred vision, cloudy urine, and confusion. Known contraindications include angioedema. 1

Left ventricular dysfunction is a condition that happens when the main pumping chamber of your heart (left ventricle) is not working well. The heart is a muscle and needs a constant supply of oxygen and blood. If the arteries that deliver the oxygen and blood are blocked, parts of the heart may become weak and not pump well. The heart may also get weak from having to constantly pump against the resistance of high blood pressure or narrow arteries.

Captopril treats HBP and congestive heart failure “Captopril is an oral drug and a member of a class of drugs called angiotensin converting enzyme (ACE) inhibitors” (Ogbru, 2014 ). “Administration of captopril results in a reduction of peripheral arterial resistance in hypertensive patients with either no change, or an increase, in cardiac output”