Congested Heart Failure

(adapted from McGraw Hill Case Studies)

Chief Complaint: 74-year-old woman with shortness of breath and swelling.

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

On physical examination, Martha's jugular veins …show more content…

6) Examination of her ankles reveals significant "pitting edema." Explain this finding. Fluid builds up in the interstitial space of her extremities (i.e. ankles) due to the changes in the hydrostatic pressure caused by the back-flow pressure originating in the heart.

7) She is advised to wear support stockings. Why would this help her? Support stockings could be used. I worked at a Med-Spa and the doctor would advise his patients to wear compression hoses after laser vein treatments if there were no other individual contraindications of use. Compression hoses prevent fluid from accumulating in surrounding tissues and interstitial spaces by directing excess fluid into other blood vessels and the lymphatic system.

8) Which term more accurately describes the stress placed upon Martha's heart -- increased pre-load or increased afterload? Increased after-load describes the stress placed upon Martha’s heart. Afterload is the pressure that the heart pumps blood against. There is increased pressure associated from left ventricular damage and narrowing of the semi-lunar valve in Martha’s diseased state, leading to the resistance of blood flow.

9) What is the general term describing Martha's condition? Right-sided congestive heart failure is the general term for Martha’s condition.

10) How might Martha's body compensate for the above condition?