The assessment findings consistent with heart failure

 

The assessment findings consistent with heart failure during this visit include:
Weight gain of 10 pounds over the last 5 days
Shortness of breath with minimal exertion
Bibasilar crackles heard when auscultating lung sounds
Oxygen saturation of 95% on room air
The APN asked about back pain, stomach pain, confusion, dizziness, or a feeling that she might faint because these symptoms could indicate other potential complications or conditions that may be contributing to or exacerbating the patient’s heart failure. It is important to assess for any additional symptoms that may require further evaluation or treatment.

The following terms indicate:

Cardiac output: The amount of blood pumped by the heart in one minute. Normal value is approximately 4-8 liters per minute.
Stroke volume: The amount of blood pumped by the heart in one contraction. Normal value is approximately 60-100 mL per beat.
Afterload: The pressure or resistance the heart must overcome to eject blood into the systemic circulation. It is determined by systemic vascular resistance. There is no specific normal value.
Preload: The volume of blood in the ventricles at the end of diastole, which stretches the ventricles and determines the force of contraction. There is no specific normal value.
Ejection fraction: The percentage of blood pumped out of the left ventricle with each contraction. A normal ejection fraction is typically above 50%.
Central venous pressure: The pressure in the right atrium, which indicates the filling pressure of the right ventricle. Normal value is approximately 2-6 mmHg.
An ejection fraction of 55% is considered within the normal range. It indicates that the heart is still able to pump a sufficient amount of blood with each contraction. However, it is important to monitor any changes in the ejection fraction over time as it can be an indicator of worsening heart function.

The body’s compensatory mechanisms during heart failure include:
Activation of the renin-angiotensin-aldosterone system: This leads to vasoconstriction and sodium and water retention, increasing blood volume and cardiac workload.
Activation of the sympathetic nervous system: This increases heart rate and contractility, but can also lead to further vasoconstriction and increased cardiac workload.
Ventricular remodeling: This involves changes in the structure and function of the heart muscle, which can initially help maintain cardiac output but can ultimately lead to further deterioration.
The Frank-Starling law states that within physiological limits, the greater the stretch (preload) on cardiac muscle fibers during diastole, the greater the force of contraction during systole. This law helps to maintain cardiac output by allowing the heart to adapt and respond to changes in preload.

Heart failure can be classified as:
Left or right ventricular failure: Left ventricular failure occurs when the left side of the heart is unable to effectively pump blood to the systemic circulation, while right ventricular failure occurs when the right side of the heart is unable to effectively pump blood to the pulmonary circulation.
Systolic versus diastolic: Systolic heart failure occurs when the heart muscle is weakened and unable to contract effectively, resulting in reduced ejection fraction. Diastolic heart failure occurs when the heart muscle is stiff and unable to relax properly, resulting in preserved ejection fraction.
New York Heart Association (NYHA) classification: This classification system categorizes heart failure based on functional limitations and symptoms.
ACC/AHA guidelines: These guidelines provide a more detailed classification of heart failure based on symptoms, structural changes in the heart, and objective evidence of heart dysfunction.
Based on the information provided, it seems that this patient may have left ventricular systolic heart failure according to the NYHA and ACC/AHA guidelines, as she is experiencing symptoms such as shortness of breath and bibasilar crackles, and has a reduced ejection fraction.

The rationale for prescribing each of the following medications is as follows:
Aspirin: Aspirin is commonly prescribed for patients with cardiovascular disease as it helps prevent blood clots by inhibiting platelet aggregation.
Clopidogrel bisulfate (Plavix): Clopidogrel is also used to prevent blood clots by inhibiting platelet aggregation, especially in patients who cannot tolerate aspirin or have a history of coronary artery disease.
Lisinopril (Prinivil/Zestril): Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that helps reduce blood pressure and improve cardiac function in patients with heart failure.
Carvedilol (Coreg): Carvedilol is a beta-blocker that helps reduce heart rate and blood pressure and improves cardiac function in patients with heart failure.
The following tests provide the following information:
Complete blood count (CBC): Provides information about red blood cell count, white blood cell count, and platelet count, which can help assess for anemia or infection.
Basic metabolic panel (BMP): Provides information about electrolyte levels, kidney function, and glucose levels.
Brain natriuretic peptide (BNP): BNP is a hormone secreted by the heart in response to increased pressure or volume. Elevated levels can indicate heart failure.
Troponin: Troponin is a marker of cardiac muscle damage and can indicate a recent myocardial infarction or other cardiac injury.
Creatine kinase (CPK) and creatine kinase-MB (CKMB): These are enzymes released by damaged muscle cells, including cardiac muscle cells. Elevated levels can indicate myocardial damage.
Albumin: Provides information about nutritional status and liver function.
Electrocardiogram (ECG): Provides information about electrical activity and rhythm of the heart.
Chest X-ray (CXR): Can help assess for signs of fluid accumulation in the lungs and evaluate cardiac size.
Echocardiogram: Provides information about cardiac structure and function, including ejection fraction and any structural abnormalities.
These tests are ordered to assess the patient’s cardiac function, identify any potential complications or comorbidities, and guide treatment decisions.