Reference no: EM134041702

Assignment:

A 63 year old women is complaining of shortness of breath, lower extremity swelling, and fatigue. In the last three months, her symptoms have become progressively worse, particularly when she engages in activities like housekeeping or walking. She notes her legs have become swollen, and she feels like she has gained weight in the past 2 weeks. She also reports two-to three- pillow orthopnea. She denies fever, chest pain, palpitations, and hemoptysis.

• Past medical history: type 2 diabetes mellitus and hypertension
• Medications: metformin 1000 mg twice per day; lisinopril 10 mg once per day
• Social history: never smoked; drinks one glass of wine per night. She denies illicit drug use. Married, lives with husband and 28 y/o son. Works in a bank.

Physical Exam:

• Vital signs: temperature 98.6 degrees F, heart rate 100 beats per minute, respiratory rate 22 per minute, blood pressure 100/60 mmHg; oxygen saturation 96% ; body mass index 33kg/m
• General: awake, alert, mild distress
• Head, eyes, ears, nose, throat: unremarkable
• Neck: no lymphadenopathy, jugular vein distension noted bilaterally
• Cardiovascular: S1 and S2 heard, an S3 gallop was heard. No murmurs or rubs were heard. Ankle and feet with 2+ edema bilaterally
• Lungs: fine crackles heard on early inspiration of bases bilaterally
• Abdomen: unremarkable

Heart failure with reduced ejection fraction (systolic heart failure) is suspected. Answer the following questions pertaining to this case:

1. Describe heart failure with reduced ejection fraction and compare it to heart failure with preserved ejection fraction.
2. What are the mechanisms that lead to heart failure?
3. Explain the reasons for the clinical manifestations in this case (shortness of breath, orthopnea, fatigue, S3 edema, jugular vein distention, and crackles).
4. What diagnostic test will be ordered to confirm the diagnosis?
5. Develop a treatment plan for this patient based on the suspicion of heart failure with reduced ejection fraction.