Case Study Discussion Post

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Case Study Discussion Post

Question 1

Heart failure is the inability of the heart to pump blood at a rate required by body tissues. Heart failure involving the heart’s left ventricle can be categorized into diastolic or systolic heart failure. Systolic heart failure relates to the pumping function and occurs during the heartbeat. Contrary, diastolic heart failure relates to the relaxing function and occurs between heartbeats. The differences between systolic and diastolic heart failure are based majorly on the Left Ventricle’s (LV) Ejection Fraction (EF). Systolic heart failure is characterized by reduced Ejection Fraction (EF), large left ventricle volume, and eccentric left ventricle re-modelling (Miranda-Silva et al., 2021). On the other hand, diastolic heart failure is characterized by normal Ejection Fraction (EF), low volume, and concentric left ventricle re-modelling characteristics (Fukuta, 2020). A stiff left ventricle with impaired relation and reduced compliance is another characteristic of diastolic heart failure. With diastolic heart failure, the body is capable of meeting the metabolic needs of the body, although with a higher diastolic pressure (Miranda-Silva et al., 2021).

Question 2

The echocardiography performed on the patient showed reduced wall motion of the anterior wall of the heart and an ejection fraction of 25%, which can be considered low. From our characteristics of systolic and diastolic heart failure above, it is evident that systolic heart failure is characterized by low EF. Also, systolic heart failure is associated with low volume. The decreased wall motion of the heart’s anterior wall can be associated with low volume. Therefore, it can be logically inferred that the patient was suffering from systolic heart failure.

Question 3

Pathophysiology of Dyspnea on Exertion

It results from the left ventricular output’s failure to rise during exercise, which results in increased pulmonary venous pressure.

Pathophysiology of edema

Edema results from a decrease in movements of water from interstitial spaces into lymphatic vessels or high movements of fluids from intravascular to interstitial spaces. It has four mechanisms: decreased plasma oncotic pressure, an increased capillary permeability, lymphatic system obstruction, and increased capillary hydrostatic pressure.

Pathophysiology of jugular vein distention

It happens when the backup of blood is in the vena cava or heart. Superior vena cava, heavy traffic on a freeway, and slow blood flow can lead to a backup of blood.

Pathophysiology of orthopnea

It occurs during recumbency when there Is congestion of pulmonary. It has little effect on a normal person but on a person with heart disease, resulting in shortness of breath because additional blood cannot be pumped by the left ventricle (Hare, 2019).

Question 4

The third heart sound is the first initial indication of left heart failure. It is also associated with low ejection fraction. The presence of a third heart sound and an ejection fraction of 25% is crucial for differentiating the type of heart failure. Differentiating systolic and diastolic heart failure is crucial because the two heart failures have different pathophysiology and histories that might require different therapeutic approaches.

References

Fukuta, H., & Little, W. C. (2020). Diastolic versus systolic heart failure. Diastolic Heart Failure, 119–133. https://doi.org/10.1007/978-1-84628-891-3_8

Hare, J. M., Felker, G. M., & Mann, D. L. (2019). In Heart failure: A companion to braunwald’s heart disease. essay, Elsevier.

Jessup, M. (n.d.). Defining heart failure: Systolic versus diastolic dysfunction, differential diagnosis, initial testing. Heart Failure: Providing Optimal Care, 51–70. https://doi.org/10.1002/9780470994757.ch4

Miranda-Silva, D., Lima, T., Rodrigues, P., Leite-Moreira, A., & Falcão-Pires, I. (2021). Mechanisms underlying the pathophysiology of heart failure with preserved ejection fraction: the tip of the iceberg. Heart Failure Reviews, 26(3), 453-478. https://doi.org/10.1007/s10741-020-10042-0Wang, Z. (2018). Left ventricular mechanics in human heart failure (Doctoral dissertation, ResearchSpace@ Auckland).