Case Study 3
Unit 5 and Unit 6
AO is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. AO also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, (potassium chloride) and sublingual nitroglycerin.
Discussion Questions 1. Which type of heart failure (left- or right-sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure? * The type of the heart failure that associated with dyspnea or difficult of breathing is the left-sided. The clinical findings that are more likely to be present in left-sided heart failure are pulmonary congestion, respiratory crackle (rale ), hypoxemia, high left atrial pressure, and acute cardiogenic pulmonary edema. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output?

3. What is the most likely cause of AO’s pedal edema?
The most likely cause of AO’S pedal edema is heart failure specially the right side heart failure due left side heart failure which leads to much pressure to right side of heart. 4. What is the cause of AO’s exertional chest pain? What laboratory tests would be useful to confirm this diagnosis?

5. What is the rationale for the use of each of AO’s medications in managing her heart disease?

h
TV is hospitalized with deep vein thrombosis (DVT) in her left leg as a complication of abdominal surgery. She is being treated with bedrest and anticoagulant therapy. On the third postoperative day, she suddenly experiences severe dyspnea and is