CASE STUDY (2009)

A 56 years old patient complain of difficulty in breathing on less than ordinary activity. He awoke many times about 2 hours after sleeping with severe dyspnea that was relieved by sitting. Pericardial examination revealed an apex in the 6th space outside the midclavicular line, a gallop on the apex and fine basal crepitations on the back.

What type of heart failure this patient has? Left sided heart failure

Enumerate the causes of this heart failure: 1. Systolic dysfunction

Decreased contractility Increased afterload Excessive preloadMyocardial infarction hypertension Mitral regurge

Valvular heart diseases eg. MR

Aortic stenosis Fluid overload

hypertension Dilated cardiomyopathy

cardiomyopathies Valvular regurgitation

2. Diastolic dysfunction stiffness of the myocardium caused by hypertension of

infiltration eg. Amyloidosis

How to stage heart failure?what is the stage of this heart failure?

Newyork classification of heart failure (NYHA)

Stage 1 Heart disease present, but no dyspnea from ordinary activity

Stage 2 Comfortable at rest: dyspnea on ordinary activityStage 3 Less than ordinary activity causes dyspnea, which is

limitingStage 4 Dyspnea at rest; all activity causes discomfort

This patient has dyspnea on less than ordinary activity, so he is in stage 3

Enumerate the factors that precipitate heart failure in patients with preexisting heart disease:

Myocardial ischaemia/ infarction Intercurrent illness eg. Infection Specific infections eg.rheumatic activity/ infective

endocarditis Arrhythmia eg. Atrial fibrillation

Inappropriate reduction of therapy Administration of drugs

B-blockers NSAIDS Corticosteroid

Pulmonary embolism Condition associated with increased metabolic demand

Pregnancy Thyrotoxicosis Anaemia

IV fluid overload