74 y.o. F

74 y.o. F

1. PCP appointment: SOB upon exertion, increased swelling in ankles getting worse over the last two months, decreased appetite, N&V, abdominal tenderness in the right upper quadrant

   • Physical Exam (PE): distended jugular veins; low-pitched, rumbling systolic murmur, heard over the left upper sternal border; an extra S3 heart sound
     • Chest x-ray is necessary to r/o disease, diagnosis, and determine which side the heart failure is on
       • Tests: Chest x-ray, ECG, & Echocardiogram. Labs: BNP, CBC, LFT, TFT, & UA
         • The patient will have these test performed on a regularly scheduled basis by PCP and/or cardilogist
       • TX starts by treating left-side heart failure first.
         • Control symptoms, reduce workload of heart, improve heart function, treat underlying disorders
           • Last resort: valve replacements, (CABG), angioplasty and/or pacemaker are options if nothing else works or symptoms worsen
           • Lasix, lopressor, HCTZ, digoxin, bumex & , spironolactone can prevent salt retention, decrease workload of heart, prevent fluid overload
             • The patient will need constant monitoring by their PCP
     • Final diagnosis based on PE: right side heart failure.
       • blood backs up into veins causes peripheral edema and organ engorement
   • Initial diagnosis based on symptoms: heart failure.
     • Poor ventricle(s) pumping function causes sx
       • Blood backing up from ventricles may cause congestion which translates to pain in RUQ, N&V which may cause decreased appetite

2. Hx of rheumatic fever (RF)

   • inflammatory disease caused by group A beta streptococci
     • Acute form: febrile illness that causes inflammation of joints, skin, nervous system, and heart
       • Untreated: can cause scarring and deformity of cardiac structures causing rheumatic heart disease
         • SX:fever, muscle aches, swollen and painful joints, and in some cases, a red, lattice-like rash
           • TX is often ineffective if started after two weeks of infection
         • Heart failure can occur
       • The heart has to work harder to pump blood
     • possibly caused by untreated strep throat; RF may be genetic
   • Can also cause a temporary nervous system disorder called chorea. Characterized by rapid, jerky, involuntary movements of the body. Occurs in childhood or during pregnancy and closely associated with rheumatic fever. Mild cases cause difficulty concentrating or writing. More severe cases can cause muscles of the arms, legs, or face to twitch uncontrollably

3. Life style changes: reduce salt intake, monitor the amount of liquids taken in, consider losing weight if necessary, stop smoking, avoid excessive alcohol

   • With treatment the patient can live a long, productive life