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A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin.

 

Discussion Questions 

 

Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure?

 

What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output?

 

What is the most likely cause of A.O.’s pedal edema?

 

What is the cause of A.O.’s exertional chest pain? What laboratory tests would be useful to confirm this diagnosis?

 

What is the rationale for the use of each of A.O.’s medications in managing her heart disease?
SCIENCE
HEALTH SCIENCE
NURSING
PATHO 370

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