Congestive Heart Failure
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Diagnosis: The patient seems to be suffering from Dilated Congestive Cardiomyopathy (DCM), or in simple terms, congestive heart failure; specifically ventricular failure.
Justification for Diagnosis: The patient said he had been suffering of acute dyspnea which would be caused by the lungs filling with fluid since the heart isn’t able to pump properly. Due to the patients hip replacement it is possible for him to have an infective agent even though he was said to not have one. Sometimes the disorder will start as acute myocarditis associated with fever if an infection is present. The patient also complained of a cough which is common in heart failure seeing as it is difficult to breathe with fluid in their lungs. He was said to have a fever which too is prominent in heart failure patients. His fever was 99.5ºF which is slight and in heart failure patients a slight fever is recognizable. The patient had trouble producing stool too and constipation is prevalent in DCM. The patient suffered of severe shortness of breath and dizziness after he produced a firm stool because of the amount of energy exerted to produce it and his lungs were unable to take in enough oxygen due to the possible fluid.
The patient has shallow, rapid respirations because of the previously mentioned reason; the fluid filling his lungs. The patients respiration rate was 28, while normal is 12-18. The patients BP was low (90/75) and heart rate was high (115) which is very common in DCM patients seeing as CO is high, but not much blood is being pumped out of the heart because the heart is ineffective and failing. The patient’s veins were distended 12cm above the right atrium with a prominent “a” wave. DCM patients have prominent vein distension because of the backup of blood in the body’s veins and tissues causing them to expand. DCM also creates an S3 or an S4 gallop because of the diastolic impulse along with a murmur sometimes. The liver was palpable because with DCM the liver becomes large and tender due to the backup of blood throughout the body which is also the reason for the pitting edema. The EKG revealed that the patient has tachycardia due to the CO needed to produce even a little bit of blood flow.
Prognosis: The average overall prognosis for patients with DCM is a 70% 5-year mortality rate. 50%-60% of severe patients die within one year, while 50% of less severe patients die in 3-5 years. 50% percent of deaths are sudden possibly indicating malignant arrhythmia.
Treatment (non-surgically): Non-surgically, treatments for DCM are to remove potential toxins or myocardial depressants, therapy for low cardiac output and heart failure, and treatment of complications. Inotropic drugs, pre-load reduction, ACE inhibitors, or hydralazine plus nitrate are the mainstay of therapy. The ACE inhibitors and hydralazine plus nitrate drugs favorably alter prognosis by prolonging life and reducing morbidity.
Treatment (surgically): Since the prognosis for these patients isn’t very good, they represent the highest proportion of heart transplant recipients. Patients under 60 years of age are preferred because of scarce organ resources, thus making it hard for the 74 year old male patient to receive a heart. A surgical procedure involving the removal of strips of myocardium to remodel the dilated ventricle is a possibility, but has shown promise in uncontrolled trials. The only controlled trial is where the latissimus dorsi muscle is wrapped around the failing ventricle and stimulated by a skeletal muscle pacemaker, but this procedure has shown to be of no value. Several ventricular assist devices are good options pending a heart transplant or as a long-term therapy rather than a transplant.