A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay

A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay

Case Overview

CH is a 66-years old African-American female presenting with shortness of breath, lower limb edema, fatigue, paroxysmal nocturnal dyspnea, orthopnea, and overweight. She has osteoarthritis and gout, myocardial infarction, and transmural anterior wall five years ago, and had two-vessel coronary artery bypass surgery due to anterior descending and left circumference coronary arteries. She is allergic to nuts, strawberries, shellfish, and hydralazine. Her current medication includes celecoxib, allopurinol, atorvastatin, aspirin, and clopidogrel. She has a positive family history of atherosclerosis, heart attack, and cerebrovascular accident A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay.

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1. Based on the limited amount of information provided above, do you suspect that this patient has developed heart failure based on the most recent guidelines? Explain your answer.

Heart failure is the inability of the heart to pump blood to meet the requirement of the metabolizing tissues. The presenting symptoms are exertional dyspnea, orthopnea, tachycardia, distended neck veins, and cyanosis (Groenewegen, et al, 2020). In the Framingham criteria for heart failure, the patient must present with two major symptoms or one major symptom with two minor symptoms. The major symptoms are paroxysmal nocturnal dyspnea and the minor symptoms are dyspnea on exertion and bilateral ankle edema.

2. What are the most common causes of CHF in an adult? Given the information in this case, which causes seems to be the most likely?

Common causes of heart failure in adults are coronary artery disease, Diabetes Mellitus, hypertension, peripartum cardiomyopathy, anemia, pregnancy, hyperthyroidism,  drugs like NSAIDs, sepsis, obesity, and family history of heart failure, and previous heart attack (Groenewegen, et al, 2020). The causes of heart failure listed in the patient’s case study are underlying structural abnormalities like the transmural anterior wall, history of myocardial infarction, use of NSAIDs like celecoxib and aspirin, and coronary artery obstruction.

3. From the information given above, identify three risk factors that probably contributed to the patient’s heart attack five years ago.

Heart attack is necrosis of the heart muscles due to a lack of oxygen supply. Often, there is an increase in oxygen demand or decreased supply due to obstruction, coronary endothelial dysfunction, coronary artery embolus, obesity, hyperlipidemia, smoking, and a sedentary lifestyle (Piekarz, et al, 2021). It presents with chest pain, fatigue, and malaise. The patient has transmural blood vessels, dyslipidemia, and smoking.

4. You are curious as to the usefulness of the S3 in making a diagnosis of CHF. You go to the literature and find two studies. The first study started with 100 patients with echocardiographically proven LV systolic dysfunction and an ejection fraction estimated at less than 35%. Of that group, 80 patients had an S3. The other study took 100 normal volunteers and performed auscultation and echocardiography. Of that group, 10 patients with normal echocardiograms had an S3. You then see a patient in your office with a history of exertional dyspnea. You estimate before examining her that she has a “50-50 chance” of having congestive heart failure. If you hear an S3, what do you then think are her chances of having CHF?

S3 heart sound is a ventricular gallop that occurs immediately after S2 when the mitral valve opens. It is a result of a large of blood striking a compliant left ventricle. Therefore, it is common in patients with heart disease, myocardial infarction, and arrhythmias (Gjoreski, et al, 2020). The two studies show a variation of S3 in different conditions of the heart. The second group was patients with a normal echocardiogram, 10 with s3 had heart failure. This is a clear indication that heart failure presents with non-specific symptoms. Therefore, the specificity and sensitivity of S3 in the diagnosis of heart failure are high in the presence of preexisting heart diseases A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay.

5. What diagnostic tests would you consider in this case?

The patient has met the Framingham clinical criteria for heart failure through her presenting symptoms. However, it has low specificity for heart failure and needs laboratory workup and echocardiogram. A complete blood count helps to rule out anemia and sepsis as the possible causes of heart failure. Electrolyte levels and renal function tests monitor kidney dysfunction in patients on heart failure treatment. Renal function test rules our glomerulonephritis, a cause of heart failure. An electrocardiogram checks the rhythm and electrical activity of the heart. It has a higher sensitivity level to heart failure and provides information on the etiology and indication for treatment methods. Chest radiographs help determine pleural effusion and cardiomegaly. Natriuretic peptide maintains the heart’s homeostasis and has a high specificity and sensitivity rate for heart failure. An echocardiogram checks the function of the heart muscles, chambers, and valves to rule out cardiomyopathy.

C.H. presented to your office with the complaint of a “racing heartbeat.” She is an overweight, 66-year-old African American female, who has been experiencing increasing shortness of breath during the past 4 months and marked swelling of the ankles and feet during the past 3 weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through the entire thickness of the ventricular wall) anterior wall (i.e., left ventricle) myocardial infarction. She received two-vessel coronary artery bypass surgery 4.5 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three-pack-per-day smoker for 30 years but quit smoking after her heart attack. She uses alcohol infrequently. She has a 9-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical history also includes diagnoses of osteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel.

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Questions

1. Based on the limited amount of information provided above, do you suspect that this patient has developed heart failure based on the most recent guidelines? Explain your answer.
2. What are the most common causes of CHF in an adult? Given the information in this case, which causes seems to be the most likely?
3. From the information given above, identify three risk factors that probably contributed to the patient’s heart attack five years ago.
4. You are curious as to the usefulness of the S3 in making a diagnosis of CHF. You go to the literature and find two studies. The first study started with 100 patients with echocardiographically proven LV systolic dysfunction and an ejection fraction estimated at less than 35%. Of that group, 80 patients had an S3. The other study took 100 normal volunteers and performed auscultation and echocardiography. Of that group, 10 patients with normal echocardiograms had an S3. You then see a patient in your office with a history of exertional dyspnea. You estimate before examining her that she has a “50-50 chance” of having congestive heart failure. If you hear an S3, what do you then think are her chances of having CHF?
5. What diagnostic tests would you consider in this case A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay?

References

Gjoreski, M., Gradišek, A., Budna, B., Gams, M., & Poglajen, G. (2020). Machine learning and end-to-end deep learning for the detection of chronic heart failure from heart sounds. IEEE Access, 8, 20313-20324. https://doi.org/10.1109/ACCESS.2020.2968900

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European journal of heart failure, 22(8), 1342-1356. https://doi.org/10.1002/ejhf.1858

Piekarz, H., Langran, C. & Donyai, P. A phenomenological analysis of the experience of taking medication to prevent a further heart attack. Sci Rep 11, 23468 (2021). https://doi.org/10.1038/s41598-021-02909-5 A Phenomenological Analysis Of The Experience Of Taking Medication To Prevent A Further Heart Attack Essay