HEART FAILURE MANAGEMENT

''HEART FAILURE MANAGEMENT''

Heart Failure Management

Aim and Justification

For the purpose of this case study the patient shall be referred to as John to ensure patient privacy and confidentiality in accordance with the Health Information Privacy Code 1994 (Burgess, 1999). John is an 80-year-old European male. He lives with his wife who is a very supportive person. John has a 20 year history of hypertension. He is an ex-smoker having given up 15 years ago. He has a family history of heart disease, hypertension and cancer. John notices feet and ankle swelling. He wakes up in the middle of the night with acute shortness of breath. He feels tired most of the time. John's medical diagnosis is Congestive heart failure.

Background

Congestive heart failure is a common syndrome in older adults and occurs in approximately 7% to 10% of people 80 years and older (Resnick, 2004). "Congestive heart failure is a pathophysiologic condition in which the heart is unable to generate an adequate cardiac output such that there is inadequate perfusion of tissues, and/or increased diastolic filling pressure of the left ventricle, such that pulmonary capillary pressures are increased" (Brashers, 2002, p.53).

Congestive heart failure is actually a complication of other cardiovascular conditions rather than a disease in itself. It is associated with numerous types of heart disease, particularly with coronary artery disease and long-standing hypertension ( Lewis, Dirksen & Heitkemper, 2004). Any factor that puts a continuous strain on the heart by increasing its work, decreasing its ability to contract and hindering or altering the flow of blood within its chambers can cause congestive heart failure (Pinneo, 1995).

Case Analysis

John's history of hypertension and his age predispose him to congestive heart failure. Hypertension is a major contributing factor, increasing the risk of congestive heart failure three times (Lewis et al., 2004). The most common risk factor for the development of congestive heart failure is age (Brashers, 2002).

As we age changes affecting our body systems take place. Due to the normal age-related changes, the elderly become more susceptible to any cardiovascular diseases (Kannel & Levin, 2003). Normal aging is accompanied by changes in cardiovascular structure and function. With age, the walls of large distributing arteries thicken and become dilated and elongated (Maheshwari, Laird-Fick, Cannon & Dehart, 2000). The thickening results mainly from an increase in intimal thickness due to cellular accumulation and to matrix deposition; fragmentation of the internal elastic membrane also occurs. The left ventricular wall and septum thickens, which increases stiffness and limits diastolic filling (Wilson & Tracey, 2000).

Structural changes during aging mainly include some left ventricular wall and septal hypertrophy due to left atrial and ventricle widening, and fibrosis of the cardiac muscle. These structural changes reduce the contracticle ability of the myocardium, the resistance that the ventricles pump against increases, the amount of elasticicity of the myocardium decreases (which increases preload), and the heart rate decreases (Lewis et al., 2004). This results in decreased cardiac output, which in turn means that less cardiac reserve is available in older ...