Case Study-Congestive Heart Failure (CHF)

Case Study-Congestive Heart Failure (CHF)

Case Study-Congestive Heart Failure (CHF)

Case Study-CHF

The 60-year-old patient in the assigned case study presents with a chief complaint of nonproductive cough and increasing shortness of breath for the past one month. Associated symptoms include reduced energy levels and breathing difficulties at night. She reports a past medical history of coronary artery disease and high blood pressure. She also has a history of hysterectomy due to heavy vaginal bleeding at the age of 40. The patient has a family history of stroke and prostate cancer. Upon administration of the physical examination, the patient displays elevated BP of 160/100 and a pulse rate of 100. She has distant air sounds upon auscultation, with late inspiratory crackles bilateral to her lower lobes. S1 and S2 are present but at a remote with s3 over the apex. She was diagnosed with congestive heart failure (CHF).

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Differential Diagnosis

Based on subjective and objective patient data, the most probable differential diagnoses are congestive heart failure, pulmonary embolism, and chronic airway disease. Based on clinical guidelines, the diagnostic criteria for CHF requires the patient to display displaced cardiac apex, pulmonary venous congestion, breathing difficulties, and fatigue, with chest radiography revealing interstitial edema (Skrzypek et al., 2018). The patient in the provided case study presented with most of these symptoms, which qualifies for CHF diagnosis. Pulmonary embolism is common among older adults above 50 years, with signs of an elevated pulse rate of about 100, elevated heartbeat, dizziness, and fatigue (Steinmann et al., 2018). On the other hand, chronic airway disease is characterized by narrowing of the airway leading to shortness of breath and cough. However, the patient does not qualify for these two diagnoses based on the previous history of CAD and hypertension.

Treatment Plan

            The care plan for the patient will be based on alleviation of the symptoms and management of the underlying causes. Antihypertensives such as angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers will be utilized to manage the patients elevated blood pressure (Osmanska, & Jhund, 2019). Cough syrups such as antitussives will also be used in managing the patient’s cough. Other additional interventions will include restricting sodium in the patient’s diet, maintaining average body weight, regular exercise, possible fluid retention, and cardiac resynchronization therapy.

References

Osmanska, J., & Jhund, P. S. (2019). Contemporary management of heart failure in the elderly. Drugs & aging, 36(2), 137-146. https://doi.org/10.1007/s40266-018-0625-4

Skrzypek, A., Mostowik, M., Szeliga, M., Wilczyńska-Golonka, M., Dębicka-Dąbrowska, D., & Nessler, J. (2018). Chronic heart failure in the elderly: Still a current medical problem. Folia Medica Cracoviensia, 58(4). DOI: 10.24425/fmc.2018.125703

Steinmann, E., Brunner-La Rocca, H. P., Maeder, M. T., Kaufmann, B. A., Pfisterer, M., & Rickenbacher, P. (2018). Is the clinical presentation of chronic heart failure different in elderly versus younger patients and those with preserved versus reduced ejection fraction?. European journal of internal medicine, 57, 61-69. DOI: 10.1016/j.ejim.2018.06.005.

sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can\’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.

Dx: Congestive Heart Failure

What is the chief complaint?

Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?

What treatment plan would you consider utilizing current evidence based practice guidelines?