Helen, an 80-year-old female, has worsening of

Helen, an 80-year-old female, has worsening of her left-sided heart failure. She is generally very tired, coughs frequently, and suffers from dyspnoea. She cannot walk long distances and needs to rest frequently. Her legs are also swollen from the knee down. She has gained 5 kg in the last few weeks, without noticeable changes to her waistline. Her current physical observations and body size measurements are: blood pressure of 137/83 mmHg; heart rate of 105 bpm; weight, 78 kg; height, 164 cm; and waist circumference of 88 cm. Helen’s previous medical history reveals a myocardial infarct following occlusion of a branch of the left coronary artery at age 52 years. Helen’s fasting blood test results aged 52: Parameter Helen’s value Reference range LDL 3.9 mmol/L <2.0 mmol/L HDL 0.7 mmol/L >1.0 mmol/L Triglycerides 4.4 mmol/L <2.0 mmol/L Glucose 4.9 mmol/L Helen's fasting blood test results aged 80: Parameter Helen's value Reference range Sodium 143 mmol/L 135-145 mmol/L Potassium 4.8 mmol/L 3.5-5.0 mmol/L Calcium 2.05 mmol/L 2.15 - 2.60 mmol/L Creatinine 140 µmol/L 45-90 µmol/L eGFR 35 mL/min/1.73m2 Haemoglobin 103 g/L > 120 g/L Research Questions 1. Define and briefly describe heart failure. 2. Identify the most likely cause of her left-sided heart failure and explain the pathophysiology underlying this. Use her blood test results at age 52 to support your explanation. 3. Explain the pathophysiology underlying her respiratory symptoms (cough, dyspnoea). 4. Explain the pathophysiology underlying her symptom of fatigue. 5. Explain which sign or symptom most likely suggests that she has also developed right-sided heart failure and explain the underlying pathophysiological mechanism. 6. Use her blood test results at age 80 to identify and explain which other organ is most likely failing as a result of her heart failure.

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