Case Scenario:
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.
Physical Exam:
BP 106/74 mmHg, Heart rate 110 beats per minute (bpm)
HEENT: Unremarkable
Lungs: 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
ECG: Sinus rhythm at 110 bpm
Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection
fraction
of 25%
Diagnosis: Heart failure, secondary to silent MI
Discussion Questions:
Differentiate between systolic and diastolic heart failure.
State whether the patient is in systolic or diastolic heart failure.
Explain the pathophysiology associated with each of the following symptoms: dyspnea
on exertion, pitting edema, jugular vein distention, and orthopnea.
Explain the significance of the presence of a 3rd heart sound and ejection fraction of
25%.
Differentiate between systolic and diastolic heart failure
Systolic heart failure occurs during a heartbeat and relates to the pumping function, whereas
diastolic heart failure occurs between heartbeats and is due to an issue with the relaxing
function. Systolic occurs during the heartbeats, has decrease in oxygen and reduced ejection
fraction. According to Chatterjee (2019) ejection fraction (EF) is a measurement of how much
blood leaves a heart ventricle every time it pumps. The more the heart pumps out, the
healthier it is. In this case the patients EF was 25%. Diastolic heart failure occurs between the
heartbeats and has preserved ejection fraction.
State whether the patient is in systolic or diastolic heart failure.
The patient is in systolic heart failure due to the ejection fraction of 25%.
This study source was downloaded by 100000872938909 from CourseHero.com on 03-25-2025 07:09:36 GMT -05:00
https://www.coursehero.com/file/102700619/nr507-week-2-casestudy-discussiondocx/
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.
Physical Exam:
BP 106/74 mmHg, Heart rate 110 beats per minute (bpm)
HEENT: Unremarkable
Lungs: 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
ECG: Sinus rhythm at 110 bpm
Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection
fraction
of 25%
Diagnosis: Heart failure, secondary to silent MI
Discussion Questions:
Differentiate between systolic and diastolic heart failure.
State whether the patient is in systolic or diastolic heart failure.
Explain the pathophysiology associated with each of the following symptoms: dyspnea
on exertion, pitting edema, jugular vein distention, and orthopnea.
Explain the significance of the presence of a 3rd heart sound and ejection fraction of
25%.
Differentiate between systolic and diastolic heart failure
Systolic heart failure occurs during a heartbeat and relates to the pumping function, whereas
diastolic heart failure occurs between heartbeats and is due to an issue with the relaxing
function. Systolic occurs during the heartbeats, has decrease in oxygen and reduced ejection
fraction. According to Chatterjee (2019) ejection fraction (EF) is a measurement of how much
blood leaves a heart ventricle every time it pumps. The more the heart pumps out, the
healthier it is. In this case the patients EF was 25%. Diastolic heart failure occurs between the
heartbeats and has preserved ejection fraction.
State whether the patient is in systolic or diastolic heart failure.
The patient is in systolic heart failure due to the ejection fraction of 25%.
This study source was downloaded by 100000872938909 from CourseHero.com on 03-25-2025 07:09:36 GMT -05:00
https://www.coursehero.com/file/102700619/nr507-week-2-casestudy-discussiondocx/
