discussion 10
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Wilkes University *
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504
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Medicine
Date
Feb 20, 2024
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docx
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Uploaded by BaldEagle01
Case 1: 50-year-old African American woman with heart failure
A 50-year-old African American woman presents to the clinic with complaints of feeling tired for the last 3 months and experiencing trouble breathing while walking 2-3 blocks. She also
reports sleeping on two pillows at night to alleviate her breathing difficulties. Her past medical history includes hypertension and arthritis. On physical examination, edema is noted in both feet.
Her current medications consist of HCTZ 12.5mg daily, verapamil SA 120mg daily, and ibuprofen 200mg twice daily for arthritis in her knee. Vitals are within normal limits, with a blood pressure of 134/84 mmHg and a heart rate of 78 beats per minute. An echocardiogram reveals an ejection fraction (EF) of 30%, indicating heart failure with reduced ejection fraction (HFrEF).
To manage her heart failure, the following steps are recommended. Firstly, optimizing the dosage of her current heart failure medications is essential to improve her symptoms. Additionally, a beta-blocker, such as carvedilol or metoprolol succinate, should be added, as it has been shown to alleviate symptoms, reduce hospitalizations, and increase survival in HFrEF patients (Iacoviello et al., 2021). Considering her hypertension, she should be on an angiotensin-
converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) to improve long-term outcomes (Tromp et al., 2022). Furthermore, an aldosterone antagonist, such as spironolactone or
eplerenone, may be considered to further improve symptoms and reduce mortality (Trom et al., 2022). Periodic monitoring of her symptoms, blood pressure, weight, and electrolytes, along with
regular echocardiograms, will aid in assessing her response to treatment and making necessary adjustments.
Non-pharmacological recommendations include advising the patient to reduce sodium intake to manage fluid retention and limiting daily fluid intake. Encouraging her to engage in a
supervised exercise program tailored to her condition is crucial, as exercise can improve heart function and overall well-being.
Case 2: 79-year-old African American woman with hypertension
A 79-year-old African American woman with a medical history of hypertension, transient
ischemic attack (TIA), and gout presents with a blood pressure reading of 145/85 mmHg and a heart rate of 82 beats per minute.
To improve her blood pressure control, it is recommended to consider optimizing the doses of her current antihypertensive medications, felodipine, and benazepril, ensuring they are at their effective doses and well-tolerated. Additionally, a low-dose thiazide diuretic, such as hydrochlorothiazide, could be added to further lower her blood pressure. Alternatively, a calcium
channel blocker with a better evidence bases for older adults, like amlodipine, may be considered
(Tromp et al., 2022).
In managing her hypertension, it is crucial to follow evidence-based guidelines, such as those provided by the American College of Cardiology (ACC)/American Heart Association (AHA), which emphasize individualized treatment based on patient characteristics, comorbidities, and medication tolerability (Heidenreich et al., 2022).
Furthermore, it is essential to review the management of her gout and ensure it is appropriately controlled. Additionally, since older adults are at an increased risk of falls, evaluating her risk factors for falls and implementing appropriate measures for falls prevention should be considered.
As always, the patient's management should be personalized to her specific medical history and response to treatment, and she should be under the care of a qualified healthcare professional.
References
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., ... & Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology
, 79
(17), e263-e421.
Iacoviello, M., Palazzuoli, A., & Gronda, E. (2021). Recent advances in pharmacological treatment of heart failure. European journal of clinical investigation
, 51
(11), e13624.
Tromp, J., Ouwerkerk, W., van Veldhuisen, D. J., Hillege, H. L., Richards, A. M.,
van der Meer, P., ... & Voors, A. A. (2022). A systematic review and network meta-
analysis of pharmacological treatment of heart failure with reduced ejection fraction. Heart Failure
, 10
(2), 73-84.
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