Question

M.D. is 69 years old, visits her GP for a repeat prescription of perindopril arginine 2.5 mg. She was diagnosed with heart failure and heart disease 1 year ago (LVEF < 40%) after a myocardial infarction and was started on carvedilol 12.5 mg. M.D. moved into a retirement village 1 year ago after the death of her husband. She is an active member of the walking group, but over the last 3 weeks she has had increased shortness of breath and fatigue after a steady 20 minute walk at the park. Since then she has reduced her level of physical activity and has also noticed swelling in her ankles despite her usual fluid tablets. She tells you that she has been having packaged soups instead of regular meals, because she finds it convenient, and is drinking more water than previously recommended (< 1.5 L/day was recommended after her heart failure diagnosis). Her medical history includes dyslipidemia, osteoarthritis, stable ischemic heart disease, and hypertension. Her current medicines (all once daily) are carvedilol 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, celecoxib 200 mg, controlled-release isosorbide mononitrate 60 mg and furosemide 20 mg. M.D. currently weighs 70 kg (up by 4 kg from last visit 6 months ago) and her blood pressure is 140/82 mmHg. Serum biochemistry (urea, creatinine and electrolytes) was normal when tested 6 weeks ago. LDL was 100 and HDL was 52. Her estimated creatinine clearance was 60 mL/min.

Discuss two (2) self-care management recommendations for M.D.

Answer 1

Answer:

M.D is a 69 years old female, moved into a retirement village 1 year ago, diagnosed with heart failure and heart disease ( LVEF < 40 % ) after a myocardial infarction, 1 year ago. Her medical history includes dyslipidemia, osteoarthritis, stable ischemic heart disease and hypertension. Her current medicines are carvedilol 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, celecoxib 200 mg, controlled-release isosorbide mononitrate 60 mg, and furosemide 20 mg. She is an active member of a walking group, but over the last 3 weeks, she has had increased shortness of breath and fatigue after a steady of 20 minutes walk. Since then she has reduced her level of physical activity and has also noticed swelling in her ankles despite her usual fluid tablets. According to her words, she has been having packaged soups instead of having her regular meals and drinking more water than recommended after her heart failure diagnosis.

Self-care management recommendations:

1. According to the above statements, M.D has had difficulty in increased shortness of breath and fatigue with her increased activity. This may be due her medical history of heart failure and heart disease, 1 year ago after a myocardial infarction. Also the changes in her regular meals, increased body weight and increased water intake cause the symptoms more likely. So the first selfcare management for M.D is to maintain a healthy diet. M.D should follow the regular meals with low cholosterol, low sodium and high fiber diet. She should control the water intake as per the recommedations after her heart failure diagnosis.

2. The second selfcare management recommendations for M.D is to follow her routine physical activities like walking, jogging, simple exercises, etc. She had noticed here that, her body weight had increased up by 4 kg from last visit 6 months ago. Also she should control her LDL cholesterol level. She should also improve the creatinine clearance level. So she should strictly try to lower her body weight below 70 kg by doing mild exercises like walking, jogging and maintain regular low cholesterol and low sodium diet. Also regarding her current medicines, the furosemide, the diuretic drug may be taken twice per day as per the consultation, if needed.