Heart Failure: A Case Study

Heart Failure
Even though heart failure is a chronic condition, acute or decompensated heart failures require ICU admission. Otherwise, patients already admitted to the ICU for other diagnoses may be affected by heart failure as a complication. Postmyocardial injury/postinfarction patients and postoperative patients are included in this category. To detect early heart failure or heart failure in compensated stages, ventricular filling pressures are evaluated against stroke volume. The ICU nurse may notice elevated cardiac filling pressures. Stroke volume may not be affected in the early stages. As the heart failure progresses, stroke volume is reduced, and tachycardia sets in. However, because of the tachycardia, cardiac output will remain
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This phenomenon clearly indicates that low cardiac output is seen in advanced stages (Marino, 2014). Measuring brain type natriuretic peptide (BNP) levels helps in the diagnosis of heart failure. A level > 100 pg/ml is used as an indicator of heart failure in patients with dyspnea of unknown cause. BNP is 50% higher in females, and it is elevated in patients with renal insufficiency. However, it remains below 100 pg/ml in those with out heart failure , A high BNP and high troponin level shows poor prognosis. Serum levels of N-terminal (NT) pro-BNP which is precursor of BNP will be elevated also. NT pro BNP rises with age, a level below 300 pg/ml will not be considered for heart failure. A value above 450 pg/mL is positive for a patient under 50; above 900 pg/mL for patients under 75 and above 1800 pg/mL for patients over 75 yearls of age ( Parillo & …show more content…
Heart failure presents with high PCWP, low cardiac output, and high BP. You may notice this situation in early postcardiopulmonary bypass patients. Diuretics and vasodilatation with nitritrates or nitroglycerin can augment cardiac output by reducing afterload. Nitroglycerine effectively causes venodilation with doses lower than 50 µg/min and arterial dilation at doses higher than 50 µg/min. Remember that the patient can develop tolerance for nitroglycerin after 16–24 hours of infusion. ACE inhibitors, though used widely for chronic management of heart failure, should not be used in combination with nitroglycerine in acute

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