In this case study, a 76-year-old patient has congestive heart failure that is the major reason for her chief complaints. Heart failure can be perceived as a syndrome caused by various factors such as HTN, diseases of coronary vessels, diseases of valves, primary myocardial disorders, etc. (The American College of Cardiology Foundation and the American Heart Association, 2021). Due to one or several influencing factors (no data from the case), the patient, in the initial phase of the CHF, had a raised intracardiac pressure with left ventricular filling and increased afterload. These mechanisms increase chronotropic and inotropic responses that slowly but surely lead to myocyte hypertrophy, first eccentric, then dilatated hypertrophy (Dharmarajan & Rich, 2017). The latter leads to residual volume after each cardiac output and, consequently, the increased pressure in the chamber.
The Cardiovascular Pathophysiologic Processes
The described above pressure influences the left atrioventricular valve and left atrium that, due to increased pressure in the left ventriculus, also start dilatating. In this period, patients have a high risk of atrial fibrillation. When the compensative mechanisms of the left atrium are exhausted, the increased pressure spreads to the vessels of the pulmonary circuit that leads to blood congestion in peripheral lung vessels, pulmonary edema, dyspnoea, and shortness of breath. The latter triggers breathing troubles during the night, and the patient has to put two pillows under the head to get an adequate amount of air.
The Cardiopulmonary Pathophysiologic Processes
Moreover, such symptoms as weight gain, abdominal swelling, and peripheral edema are consequences of congestion in the central circulatory system. When pulmonary vessels are suffering from edema, the increased pressure from it reaches the right ventriculus and atrium, slowly causing their hypertrophy. The dilatated right chambers lose the ability to contract efficiently and lead to congestions in the veins of the body. That is how congestion in the lower extremities causes peripheral edema, while congestion in the liver causes abdominal swelling and arachnogastria. The weight gain of the patient can be explained by liquids congestion and inadequate work of the heart muscle.
Diuretics
Diuretics help reduce these symptoms to enhance the condition of the patients. Diuretics are used in the management of CHF; however, they are not influencing the causing agents. Moreover, if arterial hypertension is one of the major agents causing CHF, it can also affect kidneys and lead to chronic kidney disease, raising diuretic resistance (Shah et al., 2017). The latter means the tactic of CHF treatment should be diversified, targeting major initiating factors with a daily intake of medications. If the patient has to go to the bathroom because of the diuretics, it might be essential to reconsider the pharmacological group of the drugs. Loop diuretics are the strongest ones and might cause such symptoms, and they are also not recommended for daily intake (Yancy et al., 2017). Controlling the liquids intake can help improve the condition of the patient even though most of them have low compliance in following this rule.
Racial/Ethnic Variables that May Impact Physiological Functioning
Observing such influencing factors as racial or ethnic variables, it is essential to emphasize their impact on physiological functioning. The study by Mwansa et al. (2021) proved the higher prevalence of CHF among the black race and females. The authors of the research underline various genetic factors that must be further studied and social determinants of health level such as bias and structural racism. The statistical data proved the lower 5-year survival level among black patients after heart operations comparing to white people (Mwansa et al., 2021). This means the racial and ethnic factors, along with genetic specialties, should be studied to better comprehend the predisposing nonmodifiable issues causing chronic heart failure.
Summary
Hence, the interrelations between cardiovascular and pulmonary systems are central to the pathogenesis of CHF and can explain a patient’s symptoms. The major therapeutical issue of the patient, diuretics intake, can be solved by prescription of drugs targeting the main causing agents and limiting the daily water consumption. One of the factors that can also be influencing physiological functioning during the development of CHF is racial or ethnic variables that cannot be underestimated when the treatment of the patient is considered.
References
Dharmarajan, K., & Rich, M. W. (2017). Epidemiology, pathophysiology, and prognosis of heart failure in older adults.Heart Failure Clinics, 13(3), 417–426.
Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/Ethnic and gender disparities in heart failure with reduced ejection fraction.Current Heart Failure Reports, 18(2), 41–51.
Shah, N., Madanieh, R., Alkan, M., Dogar, M. U., Kosmas, C. E., & Vittorio, T. J. (2017). A perspective on diuretic resistance in chronic congestive heart failure. Therapeutic Advances in Cardiovascular Disease, 11(10), 271–278.
The American College of Cardiology Foundation and the American Heart Association. (2021). 2021 ACC/AHA key data elements and definitions for heart failure: A report of the American College of Cardiology/American Heart Association task force on clinical data standards (Writing committee to develop clinical data standards for heart failure). Circulation: Cardiovascular Quality and Outcomes, 14(4), e000102.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., CaseyJr, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776-803.