In the case study under analysis, Luna is a 48-year-old female patient diagnosed with alcohol-induced cardiomyopathy. With the normal range of left ventricular ejection fraction (LVEF) between 50-70%, Luna’s indicators are 20%, which leads to dyspnea, fatigue, and limited daily activities (Lerman et al., 2019).
The patient’s laboratory results and vital signs are within normal limits, including her blood pressure of 112/70 mm Hg and heart rate at 68 bpm. LVEF is the main parameter to diagnose heart failure, and the goal is to maximize the management of this condition (Savarese et al., 2022). The decision to increase Carvedilol to 25 mg twice daily is the best approach. According to the New York Heart Association classification, Luna has systolic dysfunction of class III, characterized by limited physical activity and fatigue (Wright & Thomas, 2018). Carvedilol is a safe b-blocker to improve LVEF in patients with hypertensive heart disease (Dominguez et al., 2019). Other options would not be an ideal therapeutic change: Lisinopril and Spironolactone are in their maximal recommended doses for cardiovascular patients, and the level of Digoxin is within the normal limits (no need to increase it).
The offered recommendation helps optimize Luna’s therapy and choose the right dose for managing heart failure. The case proves the importance of focusing on the differences between titrating doses in patients with heart failure and hypertension. In patients with heart failure, it is obligatory to choose low doses and increase them to target ones with time, regardless of current changes (Heidenreich et al., 2022). Patients with hypertension should be prescribed low doses that can be increased if needed until the target blood pressure is achieved (World Health Organization, 2021). The idea is that heart failure treatment requires dose changes under any condition, while hypertensive patients must be checked for their vital signs (blood pressure and heartbeat) to decide if a dose change is necessary.
References
Dominguez, R. F., da Costa-Hong, V. A., Ferretti, L., Fernandes, F., Bortolotto, L. A., Consolim-Colombo, F. M., Egan, B. M., & Lopes, H. F. (2019). Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival. SAGE Open Medicine, 7. Web.
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P. Kittleson, M. M., Lee, C. S., Link, M. S., … & 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), 263-421. Web.
Lerman, B. J., Popat, R. A., Assimes, T. L., Heidenreich, P. A., & Wren, S. M. (2019). Association of left ventricular ejection fraction and symptoms with mortality after elective noncardiac surgery among patients with heart failure. JAMA, 321(6), 572-579. Web.
Savarese, G., Stolfo, D., Sinagra, G., & Lund, L. H. (2022). Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews Cardiology, 19(2), 100-116. Web.
World Health Organization. (2021). Guideline for the pharmacological treatment of hypertension in adults [PDF document]. Web.
Wright, P., & Thomas, M. (2018). Pathophysiology and management of heart failure. The Pharmaceutical Journal. Web.