Case Studies on Cardiac Function
This is the first case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points.
A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular ...view middle of the document...
* Increased preload
* Myocardial hypertrophy
* Juxtaglomerular cells release renin, activating the RAAS cascade, resulting in increased sodium and water retention.
3. What is the most likely cause of A.O.’s pedal edema?
A.O.’s pedal edema is most likely caused by venous congestion. A.O.’s venous congestion is most likely caused by increased capillary filtration and retention of protein-poor fluid from the venous system into the interstitial space.
4. What is the cause of A.O.’s exertional chest pain?
A.O.’s exertional chest pain is most likely due to angina.
What laboratory tests would be useful to confirm this diagnosis?
Lab tests that would be useful in confirming this diagnosis would be an EKG, blood tests, chest x-rays and even stress testing.
5. What is the rationale for the use of each of A.O.’s medications in managing her heart disease?
* Positive dromotropic and inotropic effects which increases stroke volume, ejection fraction, and cardiac output.
* Digitalis can also have chronotropic effects.
* All improve systemic circulation and reduce angioedema.
* Furosemide: a loop diuretic that prevents the body from absorbing too much salt. It activates prostaglandins in the kidneys to dilate vessels which results in:
* Decreased preload and central venous pressure which reduces ventricular filling pressure.
* Decrease BP, which reduces peripheral vascular resistance and decreased left ventricular end-diastolic pressure.
* KCl: used to prevent/treat low blood levels of potassium.
* In A.O.’s case, potassium is given to replace what has been lost within the body from taking the Furosemide.
* Sublingual nitroglycerin: a nitrate that is used to prevent angina by:
* Relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload.
K.R. is a 46-year-old man admitted to the emergency department with unremitting chest discomfort. The pain started while he was shoveling snow from his walkway. He had experienced chest discomfort with activity previously, but the pain had subsided with rest and he sought no medical help. This time the pain did not subside and became increasingly severe, radiating to his left arm and lower jaw. In the emergency department, an ECG and cardiac enzymes were obtained. The cardiac monitor showed sinus...