Question

Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr. Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he presents to the emergency department with fatigue, generalized weakness, and feelings of “skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some shortness of breath, and is placed on 2 L of oxygen via nasal cannula. (Learning Objective 1) a. Which of his medications might be contributing to his symptoms of generalized weakness and heart irregularities? b. For what clinical manifestations should you assess to correlate to his left-sided heart failure? c. How do his medications treat his congestive heart failure? d. How does the hypokalemia affect the effects of Digitalis?

Answer 1

A. Generalised weakness and heat irregularities may be side effect of some drugs-

Digixin -It may cause heart rhythm irregularities, nause Vomiting

Lasix - It may cause hypovolemia, Hypokalemia

Beta Blockers and ACE inhibitors also may cause Nausea Vomiting,generalized weakness.

B.The clinical assessments for Left Sided heart failure is mainly Pulmonary symptoms and fatigue due to low blood supply so systemic organs-

Shortness of breath (Dyspnea), Crackle sound in lungs, Pulmonary edema(Fluid in the lungs), Cyanosis if long time low perfusion, Dizziness, Confusion, ARF may be seen if long time kidney is hypoperfused.

C.The medicines used in heart failure is -- Digoxin( Digitalis), Diuretics, ACE inhibitors, Beta Blockers etc.

The Digoxin makes the forceful contraction to heart results cardiac output is increased and blood supply is reached to body organs.

Diuretics(Lasix) are used to excrete extra fluid from the body. So the congestion in body organs by edema (extra fluid) is relieved and pressure on heart also dicreased ( can work smoothly).

ACE inhibitors (Capitan) prevent the Angiotensin 1st to convert into Angiotensin 2nd . (The Angiotensin 2nd is Potent Vasoconstrictor and it stimulate the adrenal to release Aldosterone which increase water and Sodium retention in kidney.) So, Vasoconstriction and extra fluid is not retain in body and congestion in body is prevented.

Beta Blockers(Coreg) these drugs slow the heart (Relax the heart) Makes rhythm.

D.Hypokalemia affect the effect of Digital is-

Digoxin bind on Atipase pump(on cell) on same site as Potassium. If the Potassium is low in the body then the Digoxin bind more to Atipase pump and go into cell results high amount in body. Can not excreted by kidney in urine because Digoxin not reach to the kidney( mostly bind with cell Atipase pump).

All this condition the toxicity of Digoxin and it cause Firstly Nausea Vomiting, and toxicity cause Brady cardia.