A 72-year-old male presents to the primary care office with
shortness of breath, leg swelling, and fatigue. He reports that he
stopped engaging in his daily walk with friends three weeks ago
because of shortness of breath that became worse with activity. He
decided to come to the office today because he is now propping up
on at least 3 pillows at night to sleep. He tells the NP that he
sometimes sleeps better in his recliner chair. PMH includes
hypertension, hyperlipidemia and Type 2 diabetes. On assessment
BP 106/74, HR 110, lungs sound fine inspiratory crackles bilateral
bases, cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd
heart sound; jugular venous distention. Bilateral pretibial and ankle
2+pitting edema noted. The ECG shows Sinus rhythm at 110 bpm,
echocardiogram: decreased wall motion of the anterior wall of the
heart and an ejection fraction of 25% . The patient diagnosis with
systolic heart failure , secondary to silent MI.
Discussion Questions:
• Differentiate between systolic and diastolic heart
failure.
Systolic heart failurr identifies as heart failure with reduced ejection
fraction which does not meet the cardiac output necessary to perfuse
vital tissues (McCance et al., 2019). The heart can’t eject the
adequate amount of blood that the body needs due to the left
ventricular dilation. This condition mostly cause by coronary artery
disease and prior myocardial infarction. after the patient has suffered
an MI the non-infarcted area of the heart adjusts to the increased
demand causing remodeling of the heart muscle, also leading to
changes in the structure and function of cardiac myocytes (Munzel et
al., 2015). The remodeling which occurs in the heart affects the
effectiveness of the contractions leading to the decrease in cardiac
output, and an increase in preload in the left ventricle . In the other
hand diastolic heart failure with preserved EF can happens alone or
with systolic heart failure. The heart has a poor filling of the
ventricule causing a decreased volume of the chamber . The poorly
lusitropic ventricle can’t accept filling with blood without significant
resistance and an increase in wall retention Blood backs up in the
atria causing dilation and atrial arrhythmia.
State whether the patient is in systolic or diastolic heart
failure
The symptoms that the patient presented with shortness of breath,
leg swelling, unable to exercise due to shortness of breath, sleep on
several pillows , crackles on bilateral bases and JVD are all indicative
of systolic heart failure . The history of hypertension and diabetes
increased the patient risk of cardiac issues. Congestive heart failure
This study source was downloaded by 100000872938909 from CourseHero.com on 03-25-2025 07:08:50 GMT -05:00
https://www.coursehero.com/file/102059698/week-2-discussion-pathodocx/
shortness of breath, leg swelling, and fatigue. He reports that he
stopped engaging in his daily walk with friends three weeks ago
because of shortness of breath that became worse with activity. He
decided to come to the office today because he is now propping up
on at least 3 pillows at night to sleep. He tells the NP that he
sometimes sleeps better in his recliner chair. PMH includes
hypertension, hyperlipidemia and Type 2 diabetes. On assessment
BP 106/74, HR 110, lungs sound fine inspiratory crackles bilateral
bases, cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd
heart sound; jugular venous distention. Bilateral pretibial and ankle
2+pitting edema noted. The ECG shows Sinus rhythm at 110 bpm,
echocardiogram: decreased wall motion of the anterior wall of the
heart and an ejection fraction of 25% . The patient diagnosis with
systolic heart failure , secondary to silent MI.
Discussion Questions:
• Differentiate between systolic and diastolic heart
failure.
Systolic heart failurr identifies as heart failure with reduced ejection
fraction which does not meet the cardiac output necessary to perfuse
vital tissues (McCance et al., 2019). The heart can’t eject the
adequate amount of blood that the body needs due to the left
ventricular dilation. This condition mostly cause by coronary artery
disease and prior myocardial infarction. after the patient has suffered
an MI the non-infarcted area of the heart adjusts to the increased
demand causing remodeling of the heart muscle, also leading to
changes in the structure and function of cardiac myocytes (Munzel et
al., 2015). The remodeling which occurs in the heart affects the
effectiveness of the contractions leading to the decrease in cardiac
output, and an increase in preload in the left ventricle . In the other
hand diastolic heart failure with preserved EF can happens alone or
with systolic heart failure. The heart has a poor filling of the
ventricule causing a decreased volume of the chamber . The poorly
lusitropic ventricle can’t accept filling with blood without significant
resistance and an increase in wall retention Blood backs up in the
atria causing dilation and atrial arrhythmia.
State whether the patient is in systolic or diastolic heart
failure
The symptoms that the patient presented with shortness of breath,
leg swelling, unable to exercise due to shortness of breath, sleep on
several pillows , crackles on bilateral bases and JVD are all indicative
of systolic heart failure . The history of hypertension and diabetes
increased the patient risk of cardiac issues. Congestive heart failure
This study source was downloaded by 100000872938909 from CourseHero.com on 03-25-2025 07:08:50 GMT -05:00
https://www.coursehero.com/file/102059698/week-2-discussion-pathodocx/
