Cardiology Ward Case Studies and Heart Failure Overview

Case Studies

Patient 1: Lydia, 70 years old

• Medical History: Myocardial infarction 3 years ago.
• Symptoms:
  • Fatigue
  • Dyspnea
  • Paroxysmal nocturnal dyspnea
  • Orthopnea (relief using multiple pillows)
  • Pitting edema in legs
• Examination Findings:
  • S3 heart sound
  • Echocardiogram: Low ejection fraction
• Diagnosis: Systolic heart failure, primarily left-sided.

Patient 2: Richard, 81 years old

• Medical History: 50-year smoker
• Symptoms:
  • Fatigue
  • Pitting edema
  • Jugular venous distension
  • Hepatomegaly
• Examination Findings:
  • Echocardiogram: Normal ejection fraction, right ventricular hypertrophy
• Diagnosis: Right-sided heart failure likely due to pulmonary cause (possible emphysema).

Heart Failure Overview

Definition

• Heart Failure: A clinical syndrome where the heart cannot pump sufficient blood to meet the body's needs.
• Types:
  • Systolic Heart Failure: Decreased contractility of the ventricles.
  • Diastolic Heart Failure: Inadequate filling of the ventricles.

Pathophysiology

• Systolic Heart Failure:
  • Decreased cardiac output due to low stroke volume.
  • Decreased ejection fraction.
  • High end-diastolic volume (EDV) and pressure (EDP).
  • Causes: Myocardial infarction, dilated cardiomyopathy.
• Diastolic Heart Failure:
  • Normal ejection fraction but low stroke volume.
  • Elevated EDP due to ventricular stiffness.
  • Causes: Ventricular hypertrophy.

Symptoms

• Left-sided Heart Failure:
  • Pulmonary congestion: Pulmonary edema, dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
  • Fatigue due to decreased organ perfusion.
  • Crackles on auscultation.
  • S3 or S4 heart sounds.
• Right-sided Heart Failure:
  • Jugular venous distension.
  • Hepatomegaly (congestive hepatopathy, "nutmeg liver").
  • Peripheral edema (pitting edema).

Common Causes

• Left-sided Heart Failure: Often leads to right-sided failure. Causes: Hypertension, ischemic heart disease.
• Right-sided Heart Failure: Primarily results from left-sided failure or pulmonary conditions (cor pulmonale).

Treatment

• Medications Decreasing Mortality:
  • ACE inhibitors, ARBs, Aldosterone antagonists (Spironolactone)
  • Beta-blockers (Carvedilol, Metoprolol)
• Symptom Relief:
  • Diuretics (Thiazide, loop)
  • Vasodilators (Hydralazine with nitrates)
  • Neprilysin inhibitors for promoting natriuresis.

Examination and Diagnostic Tools

• Echocardiogram: Evaluates ejection fraction and ventricular function.
• Chest X-ray and Spirometry: Used in diagnosing pulmonary causes of heart failure.

Conclusion

• Recognizing symptoms and understanding the pathophysiology of heart failure is crucial for accurate diagnosis and management.
• Treatment focuses on reducing mortality and alleviating symptoms, with attention to the underlying causes and contributing factors.