Congestive heart failure case study scribd

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Congestive heart failure case study scribd

Overview Background The most likely causes of pediatric congestive heart failure depend on the age of the child. Congestive heart failure in the fetus, or hydropscan be detected by performing fetal echocardiography. In this case, congestive heart failure may represent underlying anemia eg, Rh sensitization, fetal-maternal transfusionarrhythmias usually supraventricular tachycardiaor myocardial dysfunction myocarditis or cardiomyopathy.

Curiously, structural heart disease is rarely a cause of congestive heart failure in the fetus, although it does occur. Atrioventricular valve regurgitation in the fetus is a particularly troubling sign with respect to the prognosis.

Neonates and infants younger than age 2 months are the most likely group to present with congestive heart failure related to structural heart disease.

The systemic or pulmonary circulation may depend on the patency of the ductus arteriosus, especially in patients presenting in the first few days of life. In these patients, prompt cardiac evaluation is mandatory.

Congestive heart failure case study scribd

Myocardial disease due to primary myopathic abnormalities or inborn errors of metabolism must be investigated. Respiratory illnesses, anemia, and known or suspected infection must be considered and appropriately managed.

See Etiology, Presentation, Workup, and Treatment. In older children, congestive heart failure may be caused by left-sided obstructive disease valvar or subvalvar aortic stenosis or coarctationmyocardial dysfunction myocarditis or cardiomyopathyhypertension, renal failure, [ 1 ] or, more rarely, arrhythmias or myocardial ischemia.

Illicit drugs such as inhaled cocaine and other stimulants are increasingly precipitating causes of congestive heart failure in adolescents; therefore, an increased suspicion of drug use is warranted in unexplained congestive heart failure.

See Etiology and Presentation. Although congestive heart failure in adolescents can be related to structural heart disease including complications after surgical palliation or repairit is usually associated with chronic arrhythmia or acquired heart disease, such as cardiomyopathy.

Etiology Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body at normal physiologic venous pressures.

Typically, the heart can respond to increased demands by means of 1 of the following: Increasing the heart rate, which is controlled by neural and humoral input Increasing the contractility of the ventricles, secondary to circulating catecholamines and autonomic input Augmenting the preload, medicated by constriction of the venous capacitance vessels and the renal preservation of intravascular volume As the demands on the heart outstrip the normal range of physiologic compensatory mechanisms, signs of congestive heart failure occur.

These signs include tachycardia; venous congestion; high catecholamine levels; and, ultimately, insufficient cardiac output with poor perfusion and end-organ compromise. See the image below. Chest radiograph shows signs of congestive heart failure CHF.

Pressure to the neck ::

Systolic dysfunction Diminished cardiac output is caused by a complex interaction of various factors. Factors such as anatomic stresses eg, coarctation of the aorta that contribute to an increased afterload end-systolic wall stressas well as neurohormonal factors that increase systemic vascular resistance, also lead to systolic dysfunction.

Diastolic dysfunction Diastolic dysfunction results from decreased ventricular compliance, necessitating an increase in venous pressure to maintain adequate ventricular filling. Causes of primary diastolic dysfunction include an anatomic obstruction that prevents ventricular filling eg, pulmonary venous obstructiona primary reduction in ventricular compliance eg, cardiomyopathy, transplant rejectionexternal constraints eg, pericardial effusionand poor hemodynamics after the Fontan procedure eg, elevated pulmonary vascular resistance.

Chronic heart failure In chronic heart failure, myocardial cells die from energy starvation, from cytotoxic mechanisms leading to necrosis, or from the acceleration of apoptosis or programmed cell death. Necrosis stimulates fibroblast proliferation, which results in the replacement of myocardial cells with collagen.

The loss of myocytes leads to cardiac dilation and an increased afterload and wall tension, which results in further systolic dysfunction. In addition, the loss of mitochondrial mass leads to increased energy starvation. Acute heart failure During acute congestive heart failure, the sympathetic nervous system and renin-angiotensin system act to maintain blood flow and pressure to the vital organs.

Increased neurohormonal activity results in increased myocardial contractility, selective peripheral vasoconstriction, salt and fluid retention, and blood pressure maintenance.

As a chronic state of failure ensues, these same mechanisms cause adverse effects. The myocardial oxygen demand, which exceeds the supply, increases because of an increase in the heart rate, in contractility, and in wall stress.

Alterations in calcium homeostasis and changes in contractile proteins occur, resulting in a hypertrophic response of the myocytes. Neurohormonal factors may lead to direct cardiotoxicity and necrosis. Characteristic findings in children with heart failure Many classes of disorders can result in increased cardiac demand or impaired cardiac function.

Cardiac causes include arrhythmias tachycardia or bradycardiastructural heart disease, and myocardial dysfunction systolic or diastolic. Noncardiac causes of congestive heart failure include processes that increase the preload volume overloadincrease the afterload hypertensionreduce the oxygen-carrying capacity of the blood anemiaor increase demand sepsis.

For example, renal failure can result in congestive heart failure due to fluid retention and anemia. Renal failure may also occur following heart transplantation as a result of long-term immunosuppression.Continuous Positive Airway Pressure (CPAP) is a form of non-invasive positive pressure ventilation (NIPPV) that is commonly used in the treatment of pulmonary oedema associated with .

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In case of failure a Simoons 2 can be in all cases well before the catheter got far mcg. NTG. as an initial congestive heart failure, [PDF] Women And Monarchy In The Screwtape Letters Illustrated With A Study A Case Presentation of.

Congestive Heart Failure secondary to Coronary Artery Disease Objectives At the end of this case study, the learner should. Congestive Heart Failure History of Present Illness. A year-old male presents to the emergency room complaining of breathlessness for the past three days.

Cardiac history is positive for a myocardial infarction three years ago followed by four-vessel coronary artery bypass surgery.

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