Alterations in the Cardiovascular and Respiratory Systems
Case Study Analysis: Congestive Heart Failure
The female patient aged 76 years presents with chief complaints of weight gain, peripheral edema, abdominal swelling, and shortness of breath. The history is congestive heart failure, but she states that she has not been taking her diuretic as she has been experiencing increased urinary frequency. She sleeps on two pillows at night to get ample air. This case analysis discusses the signs and symptoms associated with congestive heart failure focusing on the effects of cardiovascular and cardiopulmonary pathophysiologic processes, their interactions, and the impact of racial and ethnic variables on the patient’s physiological functioning.
Cardiovascular & Cardiopulmonary Pathophysiologic Processes
Heart failure occurs when the heart, through a cardiac function abnormality, does not pump the blood at rates proportionate with metabolizing tissues’ requirements or elevated diastolic filling pressure. The signal symptoms are dyspnea on exertion, progressive activity intolerance, orthopnea, weakness, paroxysmal nocturnal dyspnea, and progressive edema. Despite the medical advancements, the heart failure management that typically presents as a disease syndrome is still a challenge as replicated by the higher hospital readmission in conjunction with amplified morbidity and mortality related to heart failure (Inamdar & Inamdar, 2016). Congestive heart failure is a cardiac syndrome with secondary processes related to multisystem pathophysiology, which involves the regulation of neurochemical, abnormal structure of cardiac muscle, and wall function.
CHF is triggered by myocardial structural and functional damage. To preserve cardiac output, vital organ perfusion, stroke volume, the renin-angiotensin-aldosterone, and the sympathetic nervous systems are then stimulated to release neurohormones (Kennedy-Malone et al., 2019). Here, Angiotensin II, a RAAS end product, and potent vasoconstrictor increase systemic vascular resistance. Thus, the catecholamines are released from noradrenergic nerve endings, and the adrenal cortex is directly stimulated to increase aldosterone secretions. The secretion of antidiuretic hormone, Vasopressin, and aldosterone occasioned sodium and fluid retention with successively increased blood volume. Besides, the increased systemic vascular resistance, venous pressure, volume of blood, and reduced venous compliance and arterial pressure leads to a further increase in myocardial oxygen demand and ventricular wall stress. Eventually, the normal physiological responses are maladaptive and lead to damage to the heart, systemic, cardiopulmonary, renal vasculature, and CHF progression.
Racial and Ethnic Variables
Heart failure is prevalent among men in the general population, but the prevalence is higher among women in long-term healthcare settings. In the U.S, Blacks have the uppermost cardiovascular disease rate of approximately 47%. The figure is projected to increase to 50% by 2035 (American Heart Association 2020). In terms of ethnicity, African Americans have greater heart failure rates. Even though healthcare of heart failure patients has grown in the last decades, vital discrepancies in heart failure outcomes have persisted due to race and ethnic groups. Black patients have been presented with diverse baseline traits and effects compared to the non-blacks in various cohort experiments (Lewis et al., 2018). Age-adjusted heart failure-related death rates are more significant for Blacks, whose death rates are almost three times higher than White patients. Likewise, the rate of hospitalization for Blacks is nearly 2.50 -fold more significant than the White patients, with the healthcare costs that are considerably greater during the first year following hospitalization (Nayak et al., 2020). The relative rate of hospitalization due to heart failure has improved for the other ethnic and race minorities; the disparity for hospitalization between White and Black patients has not reduced in the past ten years.
Patient Interactions
The left ventricular HF results in pulmonary venous congestion, succeeding right ventricular dysfunction, and systemic and portal venous congestion. The patient’s clinical indicators of dyspnea at rest or on exertion, orthopnoea, and paroxysmal nocturnal dyspnea designate increased pulmonary venous congestion. The progressive lower extremity edema is connected to hepatic enlargement are the symptoms indicative of systemic venous congestion. The signs that propose heart failure are weight gain, S 3 or S 4 heart sounds, tachycardia, laterally displaced point maximum impulse, ascites, bilateral lower lobes rales, neck vein distention, and positive hepatojugular reflux. The treatment options target managing symptoms, treating the causative disease process, and resultant multisystem pathophysiology. The key considerations include fragility, polypharmacy, multiple comorbid disease processes, age-related change in pharmacodynamics and pharmacokinetics, as well as geriatric syndromes, which necessitate an individualized treatment plan.
References
- American Heart Association (2020). Cardiovascular Disease: A Costly Burden for America. Projections through 2035. The American Heart Association Office of Federal Advocacy. https://healthmetrics.heart.org/wp-content/uploads/2017/10/Cardiovascular-Disease-A-Costly-Burden.pdf
- Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of clinical medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062
- Kennedy-Malone, L., Plank, L. M., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults. Philadelphia: F.A. Davis Company.
- Lewis, E. F., Claggett, B., Shah, A. M., Liu, J., Shah, S. J., Anand, I., O’Meara, E., … Pfeffer, M. A. (2018). Racial Differences in Characteristics and Outcomes of Patients With Heart Failure and Preserved Ejection Fraction in the Treatment of Preserved Cardiac Function Heart Failure Trial. Circulation. Heart Failure, 11, (3) https://doi.org/10.1161/CIRCHEARTFAILURE.117.004457
- Nayak, A., Hicks, A. J., & Morris, A. A. (2020). Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients. Circulation: Heart Failure, 13, (8). https://doi.org/10.1161/CIRCHEARTFAILURE.120.007264