Above is a link to a patient's story. The patient's name is Kepo Savou and he was diagnosed with heart failure at an early age. Many think that heart disease, especially heart failure is a condition of the elderly; however, many people have been diagnosed with this condition as young adults.1. Discuss the pathophysiology of heart failure from the perspective of the following systems listed below.CardiovascularRespiratoryNeurologicalRenal2. Based on your study of the condition of heart failure above; what symptoms did the patient have? 3. Why is the detection of this disease so difficult? What complications in this young man presented challenges in the recognition of heart failure?4. If you were his nurse, what are the top 3 things you would tell him to focus on upon discharge

Introduction Heart failure is a syndrome. It is a syndrome of ventricular dysfunction. Left ventricular (LV) failure is due to shortness of breath and fatigue and right ventricular (RV) failure due due to peripheral and abdominal fluid accumulation. Diagnosis is chest x-ray, echocardiography, and levels of plasma natriuretic peptides. Treatment for heart failure is education, diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta-blockers, aldosterone antagonists, sodium-glucose cotransporter-2 inhibitors, neprilysin inhibitors, sinus node inhibitors, specialized implantable pacemakers/defibrillators and correction of the causes of the heart failure syndrome.Answer 1 Pathophysiology of heart failure In heart failure the heart not provide adequate blood for metabolic needs to the tissues and Cardiac related elevation in pulmonary or systemic venous pressures results in organ congestion. This condition results from abnormalities of systolic or diastolic function or both. However a primary abnormality may be a change in cardiomyocyte function, there are also changes in collagen turnover of the extracellular matrix. Cardiac structural defects (eg, congenital defects, valvular disorders), rhythm abnormalities (including persistently high heart rate), and high metabolic demands (ex. due to thyrotoxicosis) also can cause heart failure. Heart failure with preserved ejection fraction Heart failure with preserved ejection fraction also called diastolic heart failure, in this LV filling is impaired. ⦁ Increase LV end-diastolic pressure at rest or during exertion⦁ Normal LV end-diastolic volume and global contractility ⦁ Ejection fraction remains normal (≥ 50%) Diastolic dysfunction results from impaired ventricular relaxation, increased ventricular stiffness, valvular disease or constrictive pericarditis. An acute myocardial ischemia also a cause of diastolic dysfunction. Resistance to filling is increases with age, reflecting both cardiomyocyte dysfunction and cardiomyocyte loss and increased interstitial collagen deposition. Diastolic dysfunction is more common among older adults. Diastolic dysfunction is predominate in hypertrophic cardiomyopathy, other disorders with ventricular hypertrophy (like; hypertension, significant aortic stenosis) and amyloid infiltration of the myocardium. LV filling and function can also be impaired if marked increases in RV pressure shift the interventricular septum to the left. Diastolic dysfunction recognized as a cause of HF. About 50% of patients with heart failure have Heart failure with preserved ejection fraction . The prevalence of heart failure increases with age and the patients with diabetes. Heart failure with mildly reduced ejection fraction LV failure Heart failure involves left ventricular dysfunction, decreases CO and pulmonary venous pressure increases. Pulmonary capillary pressure exceeds the oncotic pressure of plasma proteins (about 24 mm Hg) then fluid eject from the capillaries into the interstitial space and alveoli and reducing pulmonary compliance with increasing the work of breathing. Fluid accumulation in alveoli cause pulmonary edema, significantly alters ventilation-perfusion (V/Q), deoxygenated pulmonary arterial blood is pass through poorly ventilated alveoli, decreasing systemic arterial oxygenation (PaO2) and causing dyspnea to patient. Dyspnea may occur because of elevated pulmonary venous pressure and increased work of breathing. In chronic LV failure, pleural effusion develops and dyspnea occurs. PaCO2 decreases and blood pH increases cause respiratory alkalosis. Interstitial edema of the small airways interferes with ventilation, elevating PaCO2. this is a sign of impending respiratory failure. RV failure In heart failure involves in right ventricular dysfunction, systemic venous pressure increases that causing fluid ejection and edema. Primarily edem happens in feet and ankles of ambulatory patients and abdominal viscera. The liver is severely affected and the stomach and intestine also become congested, fluid accumulation in the peritoneal cavity occurs which cause ascites. RV failure commonly cause moderate hepatic dysfunction which increases in conjugated and unconjugated bilirubin, Prothrombin time and hepatic enzymes (mainly alkaline phosphatase and gamma-glutamyl transpeptidase ). Renal responses Renal blood flow decreases (because of low cardiac output). Renal venous pressures increase which leading to renal venous congestion. Decreases the amount of GFR (glomerular filtration rate) and blood flow within the kidneys is redistributed. The filtration fraction and filtered sodium decreases but tubular resorption increases which leading to sodium and water retention. Blood flow is further redistributes away from the kidneys during exercise whereas renal blood flow improves during rest. Neurohumoral responses Neurohumoral response helps to increase heart function and maintain blood pressure and organ perfusion. In chronic activation of these response it is harmful to the normal balance between myocardial-stimulating and vasoconstricting hormones and between myocardial-relaxing and vasodilating hormones. Vasopressin released in response to fall in blood pressure through various neurohormonal stimuli. Increased vasopress in decrease renal excretion of free water, which contributing to hyponatremia in heart failure. Changes with aging Age related changes in cardiovascular system lowers the threshold for expression of heart failure. Interstitial collagen within the myocardium is increases, the myocardium stiffens and myocardial relaxation is prolonged. These changes lead to significant reduction in diastolic left ventricular function. Systolic function decline with aging. An age decreases myocardial and vascular responsiveness to beta-adrenergic stimulation that further disturbed the ability of the cardiovascular system in respond to increased work demands. These changes at the peak exercise capacity decreases significantly and CO at peak exercise decreases. This decline may be slowed via regular physical exercise. Hence older patients are more prone than youngers to develop HF symptoms in response to the stress of systemic disorders.Answer 2 Heart failure is epidemic. Echocardiography is one of the key investigations for diagnosis of heart failure and to ensure the correct management plan. Even though, the current manpower issues for echocardiography are major problem that must be overcome if the National Health Service (NHS) can deliver the quality of care that National Institute for Health and Care Excellence (NICE) health care professionals and patients demand. Then these challenges may resolved. Complications Cardiac Cachexia A heart failure with overweight tends to be more severe. When heart failure develops, an important indicator of a worsening condition is occurs, which is unintentional rapid weight loss . Impaired Kidney Function Heart failure affect the heart's ability to pump blood. which affect other parts of the body including the kidneys In patients with heart failure, impaired kidney function may increases the risks for heart complications, hospitalization and death. Congestion (Fluid Buildup) In left sided heart failure the fluid builds up first in the lungsthat condition called pulmonary edema. After that as right-sided heart failure develops, fluid builds up in the legs, feet and the abdomen. Fluid buildup is treatable with lifestyle measures, such as reducing salt in the diet, drugs ( diuretics). Arrhythmias (Irregular Beatings of the Heart) Atrial fibrillation A rapid shaking beat in the upper chambers of the heart is a major cause of stroke, especially for the people with heart failure. Left bundle branch blockAn abnormality in electrical conduction in the heart develops in about 30 percent of patients with heart failure.Ventricular tachycardia and ventricular fibrillationLife-threatening arrhythmias occurs in patients when heart function is significantly impaired. Some patients with heart failure may have an implanted defibrillator to protect them from arrhythmias. Angina and Heart AttacksCoronary artery disease is a major cause of heart failure a patient with heart failure is at risk for angina and heart attacks. Special care need to be taken with sudden and strenuous exertion, particularly snow shoveling during cold months.Answer 3 3 things to focus on upon discharge Check your weight every morning on the same scale when you get up before eat but after you use the bathroom. Limit fluid intake to 6 to 9 cups (1.5 to 2 liters) in a day. Take only prescribed drug from hospital, drugs take only with water not with juice or anything.