Professional Documents
Culture Documents
FAILURE
Acosta, Vincent
Alvarez, Marianne
Antig, Sofia
Bajao, Sarah
Ballesteros, Veronica
Bondoc, John
Bustilla, Janelle
Capellan, Stephen
Caruyan, Duke
Cifra, Manuel
Concepcion, Thea
Crudo, Ian
Daud, Abraham Jr.
OBJECTIVES
heart failure
Chronic heart failure
Physical Examination
LABORATORY
BNP (Brain-Type Natriuretic Peptide) 749 pg/mL
NT-proBNP 1,246 pg/mL
Fasting:
Total cholesterol 4.65 mmol/L (180 mg/dL)
LDL
2.3 mmol/L (90 mg/dL)
HDL
1.55 mmol/L (60 mg/dL)
Triglycerides 1.46 mmol/L
(130 mg/dL)
Urinalysis: Negative
ECG: atrial fibrillation, elevated t waves
CXR: Positive cardiomegaly
Component
Result
Normal Value
WBC COUNT
9.00
4.5 11.0
RBC COUNT
3.90
4.32 5.72
HEMOGLOBIN
11.50
13.5 17.5
HEMATOCRIT
37.40
38.8 50.0
MCV
86.40
80 100
MCH
29.39
27 31
MCHC
34.50
32 - 36
221
150 - 420
Neutrophil
4.3
1.8 7.8
Lymphocyte
2.0
0.7 4.5
Monocyte
4 13
Eosinophil
0-7
PLATELET COUNT
Differential Count
HISTORY
Comorbidities
factors
and/or risk
Cardiomyopathy
Valvular
heart disease
Alcohol use
Hypertension
Diabetes
Dyslipidemia
Coronary/Peripheral
vascular disease
Sleep-disordered breathing
Collagen
vascular
disease, rheumatic fever
Pheochromocytoma
Thyroid disease
Substance abuse history
History of
chemotherapy/radiation
to the chest
Rales, wheezing
Hepatojugular reflux
PROBLEMS OF THE
PATIENT THAT WOULD
REQUIRE
PHARMACOLOGICAL
INTERVENTION
Sensitivity
is 66%.
Specificity is 52%.
Edema
History
Hemoglobin
No heart failure
100pg/ml
100-300pg/ml
Above 300pg/ml
Above 600pg/ml
Above 900pg/ml
Workload
=> hypertrophy
Diuretics
Beta blockers
Cardiac glycosides
Vasodilators
Drug Group
Drugs
Beneficial Effects
Diuretics
Thiazides,
furosemides,
spironolactone
Reduced preload,
afterload; Spirono
lactone reduces
aldosterone effects
Cardiac glycosides
Digoxin
Vasodilators
Hydralazine,
isosorbide dinitrate
Reduced afterload,
preload
Angiotensin
antagonists
Captopril, losartan
Reduced remodeling,
preload, afterload,
apoptosis
Beta blockers
Carvedilol, metoprolol
Reduced afterload,
reduced remodeling,
apoptosis
DIURETICS
First
line treatment
Symptomatic
relief (edema)
Spironolactone
Aldosterone-blocking
agent
ACE INHIBITORS
Inhibit
Reduction
of heart size
Reduced requirement for other
medication for heart failure
INSTRUCTION OF
DRUG INTAKE
SPIRONOLACTONE
Tablet
Oral intake
Once or twice a day
Reduced-salt (sodium) diet
Daily exercise program
Avoid potassium-containing
salt substitutes
ENALAPRIL
Shake the oral suspension (liquid) well
Use dosing syringe or special dose-measuring
spoon or medicine cup
You may take enalapril with or without food.
DIGOXIN
Capsule, or pediatric elixir (liquid)
Oral intake
Once a day
MONITORING OF
EFFICACY
EMERGENCIES
Chest pain or pressure not relieved with rest or
after taking three nitroglycerin tablets 5 min
apart
Extreme shortness of breath
Coughing up pink, frothy sputum
Fainting spell, severe sweating, or passing out
MONITORING
ADVERSE EFFECTS
SIDE EFFECTS OF
SPIRONOLACTONE
Development of breasts in men (gynecomastia)
High levels of potassium in the blood
(hyperkalemia)
Kidney problems (renal dysfunction)
NONPHARMACOLOGICAL
TREATMENT/LIFESTYLE MODIFICATION
Diet
Maintenance
of optimal weight
Obesity= increases the workload on the heart
Salt intake should be restricted
Low fat diet => delay recurrence of significant
cardiovascular events
omega-3 fatty acids
Fluid
intake
Intense
Alcohol
intake
Damage
the myocardium
Precipitate arrhythmias
Smoking
Increases
Exercise
Bed
rest
Regular, and moderate physical activity
Dynamic exercise activities
Long-term aerobic exercise training => reverse left
ventricular remodelling
Vaccination
Influenza
CASE 2
**To present CLASS 3 CHF
Physical Examination:
General
Personal History
Intake
LABORATORY
Chest
X-ray: Cardiomegaly
BNP
= 897pg/ml
NT-proBNP = 2343pg/ml
Fasting:
Urinalysis:
+1 Albumin
ECG: elevated ST waves; Heart rate increased