A 78-year-old man is admitted to the hospital with the chief complaint of shortn
ID: 67779 • Letter: A
Question
A 78-year-old man is admitted to the hospital with the chief complaint of shortness of breath. He states the shortness of breath has been increasing over the past 2 months and is aggravated by exertion. He has found that he often awakens at night with a sensation of smothering that is partially relieved when he gets up and opens the window. He has had not ankle swelling or edema noted. Past medical history is only positive for myocardial infarction 8 years ago. He currently does not have complaints of chest pain. BP is 140/98. When the nurse listens to his heart, she hears a normal S1 and S2 with a rate of 88. When listening to the lungs, the nurse notes bibasilar crackles. There is no peripheral edema. The admission diagnosis for the patient was left-sided heart failure.
a. Describe the pathophysiology of left-sided heart failure. Please use advanced terminology as discussed in class and in your textbook.
Explanation / Answer
In the case of heart failure, the heart muscles can’t pump sufficient blood as required by the body's needs with respect to blood and oxygen.
It’s a chronic and progressive condition. We can say heart is not able to carry its workload and it will be damaged. It is considered as a common end point for many cardiovascular related diseases.
The heart failure is due to the failure of left ventricle and mostly because of left ventricle systolic dysfunction.
The pathophysiology of left sided heart failure
The left sided heart failure produce changes to the heart itself:
Neuhormonal: sympathetic activity, vasopressin will be observed.
Cellular changes: which result in program cell death (apoptosis), increase amount of fibrous tissue and changes in hemodynamics.
The heart will be overloaded with blood which results in educed contractility or force of contraction and heart muscle contraction becomes less efficient. (This is due to reduced ability to cross link actin and myosin filaments in over stretched heart muscle). The heart will start pumping the blood at a faster rate.
The narrowing of blood vessels can be seen in the body and diverting of blood also will be there.
This will be seen causing congestion of pulmonary vasculature and results in respiratory problems
The failure of systole, diastole or both, will result in a reduced stroke volume and reduced contractility results in increased end systolic volume.
The compliance of ventricle falls and results in impaired ventricular filling (decreased end diastolic volume)
In order to improve contractility, the heart will increase its size (Hypertrophy- caused by terminally differentiated heart muscle fibres) and whish give rise to stiffness and heart will not be able to relax during diastole.
The heart may experience cardiac arrest when it undergoes so much of strain to give the cardiac output.
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