The physician confirms your suspicions and indicates that J.M. is ...

[big1devin]

The physician confirms your suspicions and indicates that J.M. is experiencing symptoms of early leftsided heart failure. A two-dimensional (2D) echocardiogram is ordered. Medication orders are written.
 
  Medication Orders
  Enalapril (Vasotec) 10 mg PO twice a day
  Furosemide (Lasix) 20 mg PO every morning
  Carvedilol (Coreg) 6.25 mg PO twice a day
  Digoxin (Lanoxin) 0.5 mg PO now, then 0.125 mg PO daily
  Potassium chloride (K-Dur) 10 mEq tablet PO once a day
 
  For each medication listed, identify its class and describe its purpose for the treatment of HF.

Question 2

J.M. tells you he becomes exhausted and has shortness of breath climbing the stairs to his bedroom and has to lie down and rest (put my feet up) at least an hour twice a day.
 
  He has been sleeping on two
  pillows for the past 2 weeks. He has not salted his food since the physician told him not to because of
  his high blood pressure, but he admits having had ham and a small bag of salted peanuts 3 days ago.
  He states that he stopped smoking 10 years ago. He denies having palpitations but has had a constant,
  irritating, nonproductive cough lately.
 
  You think it's likely that J.M. has heart failure (HF). From his history, what do you identify as
  probable causes for his HF?

[janeli1]

Answer to Question 1

Enalapril (Vasotec): Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors prevent sodium
and water resorption by inhibiting aldosterone secretion, resulting in diuresis, which decreases
blood volume and blood return to the heart. As a result, the workload of the heart is decreased.
Furosemide (Lasix): Loop diuretic. Loop diuretics are given to decrease fluid volume (preload).
Carvedilol (Coreg): Nonspecific beta-blocker. Beta-blockers work to reduce or to block sympathetic
nervous system stimulation of the heart and of the heart's conduction system (cardioprotective
action). As a result, the heart rate is reduced.
Digoxin (Lanoxin): Cardiac glycoside and inotropic drug. This drug increases myocardial contractility
(positive inotropic effect), resulting in enhanced cardiac efficiency and output.
Potassium chloride (K-Dur): Electrolyte supplement. This supplement is given to replace potassium
that might be lost with diuretic therapy.

Answer to Question 2

HTN: Chronic HTN can require the heart to pump hard against the resistance of the vessels. This
results in cardiac muscle hypertrophy (the cardiomegaly seen on his CXR study).
CAD: Ischemic myocardium is not able to produce adequate stroke volumes.
Anemia: Anemia decreases the availability of oxygen to all tissues of the body, and the heart
responds by increasing blood flow (stroke volume and/or heart rate), thereby increasing the
oxygen demands of the heart and contributing to myocardial ischemia. However, keep in mind
that hemodilution (from fluid volume excess) might cause his Hct to appear low