Congestive Heart Failure A.Y. F, Room 611(2) was admitted 2/9/2013. Patient came to ER complaining of mid.

Sternal chest pain. Patient stated the pain felt as if an elephant was sitting on her chest. Patient stated she took Vicodin with no relief. Patient stated she is afraid and also took nitro. Advance directives exist. Patient is a nonsmoker. Height: 61.00 inches. Weight: 157.00 lbs. BMI: 29.70. Allergic to cow fat, penicillin, tetanus toxoid, Bactrim, Cipro, tape, and band aids. Heart failure is the inability of the heart to pump enough blood to meet the metabolic demands of the body. Decreased tissue perfusion stimulates compensatory mechanisms that lead to vascular congestion and congestive heart failure. The mechanisms include: the sympathetic nervous system increases heart rate and contractility, vasoconstriction increases venous return and ventricular filling, increasing the force of contraction, renin-angiotension-aldosterone system activation leads to sodium and water retention, ventricular remodeling with dilation and hypertrophy. Cardiac reserve falls in heart failure leading to activity intolerance and dyspnea on exertion. The causes of congestive heart failure include impaired myocardial contraction (patient had a previous MI), excessive workload (hypertension; patient has), acute excess demands (fluid volume overload; patient has edema) and decreased cardiac output. Other s/s include weight gain, nocturia, and dyspnea at rest (patient has). Diagnostic tests used to diagnose congestive heart failure include a chest x ray (patient had one done; showed a new mild pulmonary vascular congestion along with small bilateral pleural effusions; left lung base opacity), and an echocardiogram.