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Why Did Mr Stone Develop Heart Failure

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Association Between Arterial Stiffness And Heart Failure With Preserved Ejection Fraction

Approach to Pediatric Heart Failure
  • Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

Cardiovascular diseases are the leading cause of mortality in the world. Heart failure with preserved ejection fraction accounts for about half of all heart failure. Unfortunately, the mechanisms of HFpEF are still unclear, leading to little progress of effective treatment of HFpEF. Arterial stiffness is the decrement of arterial compliance. The media of large arteries degenerate in both physiological and pathological conditions. Many studies have proven that arterial stiffness is an independent risk factor for cardiovascular disorders including diastolic dysfunction. In this perspective, we discussed if arterial stiffness is related to HFpEF, and how does arterial stiffness contribute to HFpEF. Finally, we briefly summarized current treatment strategies on arterial stiffness and HFpEF. Though some new drugs were developed, the safety and effectiveness were not adequately assessed. New pharmacologic treatment for arterial stiffness and HFpEF are urgently needed.

The Frequent Forgotten And Often Fatal Complication Of Diabetes

  • David S.H. Bell, MB, FACE
  • From the Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
  • Address correspondence and reprint requests to David S.H. Bell, MB, FACE, 1808 Seventh Ave. S., Rm. 813, Birmingham, AL 35294. E-mail: dbellendo.dom.uab.edu
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    This Problem Has Been Solved

    Why did Mr. Stone develop heart failure?

    The patient is a 60-year-old male who has hypertension and heartfailure. He had Hydrochlorothiazide prescribed by MD for hishypertension a couple of years ago. However, the patient has nottaken the medications as directed. He complains that he isexperiencing increasing fatigue, shortness of breath, paroxysmalnocturnal dyspnea and weight gain. An ECG and a chest x-ray wereperformed and also had blood drawn. The patient is alert andoriented. His bp was 168/96 mmHg, the temperature was 98.4, pulse98/min and RR was 22/min. Oxygen saturation 90% on room air andincreased to 94% with oxygen at 2 liters/min, per nasal cannula.The nurse administered Enalapril 5 mg PO.

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    What Other Information Should I Know

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly, and blood tests should be done occasionally.

    Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking hydrochlorothiazide.

    Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.

    It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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    Why Did Mr Stone Develop Heart Failurethe Patient Is A 60

    Why did Mr. Stone develop heart failure?

    The patient is a 60-year-old male who has hypertension and heartfailure. He had Hydrochlorothiazide prescribed by MD for hishypertension a couple of years ago. However, the patient has nottaken the medications as directed. He complains that he isexperiencing increasing fatigue, shortness of breath, paroxysmalnocturnal dyspnea and weight gain. An ECG and a chest x-ray wereperformed and also had blood drawn. The patient is alert andoriented. His bp was 168/96 mmHg, the temperature was 98.4, pulse98/min and RR was 22/min. Oxygen saturation 90% on room air andincreased to 94% with oxygen at 2 liters/min, per nasal cannula.The nurse administered Enalapril 5 mg PO.

    Long term hypertension can lead to heart failure:

    Mechanism behind it is, left ventricular hypertrophy.As due toincreasing blood pressure there occurs increasingly resistance toblood pumping by the left ventricle into the aorta.This increasedresistance leads to building of muscle fibers in the left ventriclewall leading to its hypertrophy

    This leads to narrowing of the left ventricle chamber.So theamount of blood present in the chamber decreases leading to reducedstroke volume which in turn leads to heart failure

    Add Answer to:

    Why did Mr. Stone develop heart failure?The patient is a 60-year-old male who has hypertension…

    Why Did Mr Stone Develop Heart Failure

    AFRAID of Full Body Routines! (3 Reasons Why You’ll HAVE to Change!)

    Why did Mr. Stone develop heart failure? The patient is a 60-year-old male who has hypertension…Why did Mr. Stone develop heart failure?

    The patient is a 60-year-old male who has hypertension and heart failure. He had Hydrochlorothiazide prescribed by MD for his hypertension a couple of years ago. However, the patient has not taken the medications as directed. He complains that he is experiencing increasing fatigue, shortness of breath, paroxysmal nocturnal dyspnea and weight gain. An ECG and a chest x-ray were performed and also had blood drawn. The patient is alert and oriented. His bp was 168/96 mmHg, the temperature was 98.4, pulse 98/min and RR was 22/min. Oxygen saturation 90% on room air and increased to 94% with oxygen at 2 liters/min, per nasal cannula. The nurse administered Enalapril 5 mg PO.

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    How To Manage The Increasing Complexity Of Hf Management

    The 2017 HF ECDP was motivated by an increasingly complex HFrEF management environment and the need to assist clinicians in navigating it . In the 3 years since its publication, GDMT for HFrEF now has additional medications that improve patient outcomes, thus further increasing the complexity of achieving target GDMT in all patients with HFrEF. As detailed in , the modulation of 12 pathophysiological targets has now been shown to improve symptoms and/or outcomes for patients with HFrEF.

    Table 14 Important Pathophysiological Targets in Chronic, Hemodynamically Stable HFrEF and Treatments

    Surgical or percutaneous mitral valve repair
    Reduced aerobic capacity Aerobic exercise training

    ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor-neprilysin inhibitor; HFrEF = heart failure with reduced ejection fraction; HYD/ISDN = hydralazine/isosorbide dinitrate; SGLT2 = sodium-glucose cotransporter-2.

    Principle 1: GDMT is the foundation of HF care, and the GDMT with the highest expected benefit should be prioritized. Based on large randomized trials for HFrEF, ARNIs, evidence-based beta-blockers, aldosterone antagonists, and SGLT2 inhibitors are first-line medications for all populations. HYD/ISDN is also a first-line medication for self-identified African Americans. Ivabradine is a second-line medication for select populations.

    Scenario: Worsening renal function or hyperkalemia.

    Scenario: Symptomatic hypotension.

    How To Initiate Add Or Switch To New Evidence

    Established therapies for chronic HFrEF include ARNIs, angiotensin-converting enzyme inhibitors , angiotensin receptor blockers , beta-blockers, loop diuretics, aldosterone antagonists, hydralazine/isosorbide dinitrate , and ivabradine, an If channel blocker highly selective for the sinoatrial node pacemaker current. With the exception of loop diuretics, all of these therapies have been shown in randomized controlled trials to improve symptoms, reduce hospitalizations, and/or prolong survival . Use of digoxin as a treatment for HFrEF lacks new data; most of its use in modern HFrEF management focuses on its role as a rate control agent for atrial fibrillation in those with low blood pressure.

    Following the publication of the 2017 ECDP focused on optimizing therapy for HFrEF, more data have emerged to support an expanded role for ARNIs in patients with HFrEF. These data include their use as a de novo therapy in some patients naive to ACEIs or ARB therapies , evidence for rapid improvement in patient-reported outcome measures , and the demonstration of a reverse-remodeling effect of ARNIs in chronic HFrEF, independent of background therapy with ACEIs/ARBs . It is not yet clear that de novo initiation is best for all patients with HFrEF , and we do recognize access challenges for some patients with regards to payer coverage and associated costs of ARNIs.

    Table 1 Starting and Target Doses of Select GDMT and Novel Therapies for HF

    5.1.1 Initiating GDMT

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    Case Study On A Patient With Heart Failure

    Info: 4157 words Nursing Essay 13th Feb 2020

    Mr. SB, 60-year-old male is a retiree and was admitted to the hospital accompanied by his daughter. He is 100kg at a height of 180cm so his calculated body mass index was 30.9 indicating that he was overweight. When admitted, patient was complained of shortness of breath for 2 weeks and was worsening on the day of admission. Besides, he also experienced orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling up to his thigh. Mr. SB was admitted to the hospital for to the same problem last year.

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    Mr. SB had known case of heart failure since 3 years ago and he had also diagnosed with hypertension for 5 years. Before admitted to the hospital, patient was taking frusemide 40mg, aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and simvastatin 40mg for his hypertension and heart failure. Patient does not allergic to any medication and he does not take any traditional medicines at home. His family history revealed that his father had died of ischemic heart disease 4 years ago while his brother has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years and the calculated smoking pack years was 5 pack years. Besides, Mr. SB also drinks occasionally.

    Does Arterial Stiffness Relate To Hfpef

    Gallstones: Causes and Risk Factors

    Although many studies reported the associations among arterial stiffness, diastolic dysfunction, and HFpEF, till now there is very few evidence to prove that arterial stiffness is a key factor which drives the development of HFpEF. A study conducted by Wan et al. showed that, in 488 hypertensive patients with HFpEF, two arterial stiffness parameters, arterial pressure volume index and arterial velocity pulse index , were both significantly associated with the onset of HFpEF. Another case control study which included 77 matched pairs demonstrated that, participants with decreased aortic distensibility were more easily to develop HFpEF with asymptomatic diastolic dysfunction . However, negative association between arterial stiffness and HFpEF was also reported. In the Health ABC study, the authors divided 2,290 elderly participants into three groups based on the tertiles of PWV measured at baseline. This study demonstrated that, after adjustment for conventional cardiovascular risk factors, compared to participants with low PWV , participants with high PWV were not significantly associated the high risk of HFpEF with the mean follow-up time of 11.2 years . More large prospective studies are warranted to further investigate the relationship between arterial stiffness and HFpEF.

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    Liver Size And Hepatojugular Reflux

    The key component of the abdominal examination is the evaluation of liver size. Hepatomegaly may occur because of right-sided heart failure and venous congestion.

    The hepatojugular reflux can be a useful test in patients with right-sided heart failure. This test should be performed while the patient is lying down with the upper body at a 45-degree angle from the horizontal plane. The patient keeps the mouth open and breathes normally to prevent Valsalva’s maneuver, which can give a false-positive test. Moderate pressure is then applied over the middle of the abdomen for 30 to 60 seconds. Hepatojugular reflux occurs if the height of the neck veins increases by at least 3 cm and the increase is maintained throughout the compression period.18

    Understand The Causes And Conditions Leading To Hf

    Most people who develop heart failure have another heart condition first. The most common conditions that can lead to heart failure are coronary artery disease, high blood pressure and previous heart attack. If youve been diagnosed with one of these conditions, its critical that you manage it carefully to help prevent the onset of heart failure.

    The American Heart Association is here to help. The best thing you can do for yourself is to follow all of your healthcare providers instructions and make any needed changes in diet, physical activity and lifestyle. This will help give you the highest possible quality of life.

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    What Should I Know About Storage And Disposal Of This Medication

    Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture . Do not allow the liquid or capsules to freeze.

    It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.

    Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.

    What Members Of The Interprofessional Health Care Team Provide Palliative/hospice Care And What Roles Do They Play

    What are kidney stones, what causes them, and how do I prevent them?

    What members of the interprofessional health care team provide palliative/hospice care, and what roles do they play?

    2. From the report, what clinical manifestations did the nurse obtain that indicate diabetes mellitus type 1? What additional report information would the nurse need before beginning care for Billy?

    3. You have a patient with a suspected skin infection on his leg. What standard and isolation precautions do you need to follow? Why?

    4. What are the types and classifications of antibiotics, and their actions? What type of antibiotic should the nurse administer for this client and why?

    5.mr stone is hypertension and did not take his medication as directed, he recently notice a weight gain.He came to the hospital because he develop a heart failure, ;Why did Mr. Stone develop heart failure?

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    Blood Pressure And Heart Rate

    The patient’s blood pressure and heart rate should be recorded. High, normal or low blood pressure may be present. The prognosis is worse for patients who present with a systolic blood pressure of less than 90 to 100 mm Hg when not receiving medication .16 Tachycardia may be a sign of heart failure, especially in the decompensated state. The heart rate increases as one of the compensatory ways of maintaining adequate cardiac output. A decrease in the resting heart rate with medical therapy can be used as a surrogate marker for treatment efficacy. A weak, thready pulse and pulsus alternans are associated with decreased left ventricular function. The patient should also be monitored for evidence of periodic breathing .

    Informed Refusal Of Treatment

    Usually, left ventricular assist devices are employed as a bridge to heart transplant . It follows that they should be discontinued once one is no longer a candidate for transplant. Unfortunately the decision is not that easy; recent research suggests that a significant number of patients with advanced cardiomyopathy show a reduction in heart size and improvement in left ventricular function after receiving these devices . This recent data must be shared with the patient and a recommendation made about whether to keep the device for a certain period of time before discontinuation. Of course the ultimate decision will depend upon the nature of the original consent and upon a sincere discussion with the patient about the recent clinical findings. It must be emphasized that the decision either to persist with a treatment or discontinue it and bear the consequences rests with the patient; this is the doctrine of informed refusal of treatment. It is particularly applicable if the initial consent was for transient use of the device .

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    Is There A Link Between Hbp And Heart Failure

    Heart failure, a condition where your heart is unable to provide enough blood to the body, can take years to develop inside your body. The narrowing and blocking of blood vessels caused by high blood pressure; increases your risk of developing heart failure.

    • High blood pressure adds to your hearts workload: Narrowed arteries that are less elastic make it more difficult for the blood to travel smoothly and easily throughout your body causing your heart to work harder.;
    • Over time, a higher workload leads to an enlarged heart: In order to cope with increased demands, the heart thickens and becomes larger. While it is still able to pump blood, it becomes less efficient. The larger the heart becomes, the harder it works to meet your body’s demands for oxygen and nutrients.

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