Heart Failure, Case Study Example

Medically speaking, heart failure is a condition in which the heart cannot pump enough blood in relation to the venous return and the metabolic requirements of body tissues. Extreme exertion may cause heart failure in persons with normal hearts if there exists a discrepancy between the needs of the body and the volume of blood pumped by the heart. Heart failure may also be categorized as cardiac mechanical failure, myocardial failure, and arrhythmic failure.

As to the heart’s anatomy/physiology, it is enclosed within the pericardium sac and rests on the diaphragm between the lower borders of the lungs and the middle of the mediastinum or sternum. The layers of the heart, starting from the outside, are the epicardium, the myocardium, and the endocardium. The chambers of the heart includes two ventricles with thick muscular walls, making up the bulk of the organ, and two atria with thin muscular walls. A septum separates the ventricles and extends between the atria which divides the heart into the left and right sides.

The left side pumps oxygenated blood from the pulmonary veins into the aorta and to all parts of the body. The right side pumps deoxygenated blood received through the venae cavae into the pulmonary arteries. The sinoatrial node in the right atrium initiates cardiac impulse which causes the atria to contract. The atrioventricular node in the septal wall of the right atrium spreads the impulse over the bundle of His which causes the ventricles to contract. Both atria contract almost simultaneously, followed quickly by the nearly simultaneous contraction of the ventricles. The valves of the heart include the tricuspid valve between the right atrium and the right ventricle, the mitral valve between the left atrium and the left ventricle, the aortic valve at the exit of the left ventricle, and the pulmonary valve at the exit of the right ventricle.

For an individual that has experienced heart failure, depending of course on whether the individual survived heart failure, he/she would visit a cardiologist who specializes in diseases and conditions associated with the human heart. These highly trained physicians diagnose and treat diseases and conditions related to the heart itself and all of the vessels and arteries associated with it, also known as the cardiovascular system. Most cardiologists specialize in such areas as cardiac electrophysiology, echocardiology or the application of ultrasound to help diagnose the physical maladies that lead to heart failure, and interventional cardiology which involves inserting catheters into the main arteries to determine blockage or some kind of structural problem.

Some of the symptoms associated with heart failure (i.e., symptoms that might occur before heart failure) are generally based on a physical examination that is divided into signs or symptoms caused by the effects of cardiac failure on other body organs and those associated with the heart itself, the arteries, and veins. Some of the extracardiac symptoms (or those that occur outside of the heart) includes ascites or the accumulation of fluids or edema within the heart, bronchial wheezing, hydrothorax or the non-inflammatory accumulation of serous fluid in the atriums, ventricles, or both, enlargement of the liver, moist rales or uncommon or abnormal respiratory sounds heard during inhalation, and splenomegaly or the abnormal enlargement of the spleen. Some of the internal cardiac signs or symptoms associated with heart failure includes abnormalities in the jugular venous pulsation or pulsations in the jugular vein caused by waves transmitted from the right side of the heart by circulating blood, abnormalities with the carotid pulse via the carotid artery, and abnormal cardiographic tracings of the apex wave associated with a cardiogram examination.

Once again, if a person is fortunate enough to survive heart failure, the cardiologist will diagnose the problems associated with the heart and then proceed to use a number of procedures and tests to determine the extent of damage to the heart and why it failed in the first place. First, the cardiologist will perform some blood tests to determine the “levels of important substances, such as sodium and potassium, albumin, and creatinine.” Second, X-rays are taken of the heart itself in order to show “whether the heart is enlarged or if there is congestion in the lungs;” third, an electrocardiogram which helps to determine “whether the patient has had a heart attack, if the left ventricle is thickened, and if the heart rhythm is abnormal” (Common Tests for Heart Failure, 2013).

Fourth, an echocardiography which produces images that show “how thick the heart muscles are and how well the heart pumps” the required amounts of blood; fifth, an exercise stress test which determines “if the heart is responding normally to the stress of exercise, and whether the blood supply has been reduced in the arteries;” sixth, a radionuclide ventriculography which determines “how well the heart muscle is supplied with blood, how well the heart’s chambers are working, and whether parts of the heart have been damaged” by heart failure; and seventh, cardiac catheterization which shows “blockages in the coronary arteries” that may have affected the ability of the arteries to feed the heart with the required amounts of blood (Common Tests for Heart Failure, 2013).

The treatment for heart failure commonly involves a reduction in the workload of the heart, the administration of certain drugs, such as digitalis to increase myocardial contractility and cardiac output, a salt-free diet, diuretics, and in extreme cases surgical intervention. In this last treatment option, heart surgery is performed to correct heart defects, to replace damaged valves, to open or bypass blocked vessels and arteries, or to graft a prosthesis, such as a shunt. Overall, the success of treatment for heart failure depends on how much the heart has been damaged and if so where the damage has occurred, such as in the heart walls and/or the atria and ventricles.

The outcome and/or prognosis for heart failure, much like the various treatment options, depends upon how much the heart has been damaged and where the damage has occurred. According to the American Heart Association, the early stages of heart failure

“can often be managed with medication and a healthy lifestyle,” but as the disease or condition that caused heart failure progresses, “the heart becomes weaker and treatment becomes more complex” which only exacerbates the long-term prognosis for recovering from heart failure (Common Tests for Heart Failure, 2013).

The American Heart Association also provides a number of steps or actions that a patient can use to help in their recovery from heart failure–1), a yearly heart failure review which includes discussions with the cardiologist on the patient’s “functioning, current treatment goals, and preferences for treating possible emergencies, such as kidney failure or sudden cardiac arrest;” 2), discussions related to reassessing treatment options or new treatment methods that have been developed since the initial heart failure incident; 3), discussions on palliative care in order to help manage additional symptoms; and 4), developing a care plan related to “the quality of life, the loss of independence, and the impact of worsening symptoms” which of course is dependent on the age of the patient (Common Tests for Heart Failure, 2013).

References

Common tests for heart failure.” (2013). The American Heart Association. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/Symptoms

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