Question

Mrs Brown, a 78 year-old female, was admitted to the Emergency Department at 6am after waking up with severe breathlessness. Her family informed you that the patient has a history of heart failure that had been diagnosed two years ago. On admission to the Emergency Department the clinical manifestations were:

• Severe dyspnoea
• Respiratory rate of 24 breaths/minute
• SpO₂ 85%, on room air
• BP 170/95mmHg
• Pulse rate of 120 beats/minute, in atrial fibrillation
• Auscultation of lungs identifies bilateral basal crackles

A diagnosis of acute exacerbation of chronic heart failure was made.

Question:

Explain the pathogenesis causing the clinical manifestations with which Mrs Brown presented.

I NEED 1000 WORDS for pathogenesis.

Answer 1

Heart failure is a complex clinical syndrome characterized by impaired myocardial function and progressive activation of the neuroendocrine system leading to circulatory insufficiency and congestion. Data suggest that the life time risk of developing heart failure is about 20 percent.

Signs and symptoms.

Dyspnea, fatigue, dizziness, palpitation, syncope anorexia.

The main signs of fluid overload include.

Acute cardiogenic pulmonary edema.

Cracles on auscultation

Jugular venous distention.

Edema

Ascitis.

S3 gallop.

Pulsus alterans. (low amplitude pulse in advanced stages.

Acute decompensation refers to episode of acute or subacute worsening of clinical signs and symptoms of heart failure due to a wide range of precipitates. The most common cause include dietary indiscretion, medical non compliance and arrhythmias especially atrial fibrillation.

Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. The clinical manifestation include dyspnea, cough, pulmonary crackles, and low saturation levels.

Cause of A F

Factors like IHD, Hyperthyroidisim MI, valvular disease, HTN leads to myocardial dysfunction, which leads to decreased cardiac output leading to activation of renin angiotensin aldosterone system. Increased levels of aldosterone cause ventricular remodelling. As a result of ventricular remodelling the conduction system is impaired resulting in arrhythmias.