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Case study on congestive heart failure

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Please help me with these questions based on case study (at the end of my post)
1. Varicose veins are an indication of what problem associated with CHF?
2. What drugs are commonly prescribed to deal with CHF (please give at least 3 different classes of cardiac medication)?
3. What changes to his lifestyle can this patient implement to reduce the risk of congestive heart failure?

Case
Presentation: A 53 year-old man came to the emergency department complaining of chest pains while working in the yard.

History: The patient was recently promoted to a management position at an insurance company in the Hartford area. He quit smoking for his 50th birthday but maintains a diet of steak and potatoes with ice cream for desserts most nights.

Signs & Tests:
HR - 65 bpm
BP - 185/65
ECG - evidence of left ventricular hypertrophy (enlargement) and extra ventricular beats
lipids - total cholesterol: 288 mg/dL
HDL (High-Density Lipoprotein; "good" cholesterol): 48 mg/dL

Diagnosis: Congestive Heart Failure (CHF) is the result of damage to the muscle of the heart that makes it work less efficiently. Blood is not pumped through the system as well as it could and can back up in certain organs, which is where the term "congestion" comes from.

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Solution Preview

1. The "congestion" part of congestive heart failure, as you've stated at the bottom, was drawn from the fact that there is congestion of venous circulation into the heart as it cannot effectively pump the blood out. Varicose veins are a result of venous congestion and limb edema, as venous blood from the legs is not able to be pumped back up to the heart ...

Solution Summary

We discuss a case of congestive heart failure with underlying of hypertension and dyslipidemia, along with common medical treatment and suggested behavioral modification.

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See Also This Related BrainMass Solution

Case study on diabetes and congestive heart failure

Case Study Three

Present Illness

Mr. Tompkins is a 62-year-old Native American male. He comes in because of increasing dyspnea on minimal exertion (DOE) and swelling in his legs for the past week. He has also noticed that his lower legs are red, warm to the touch, and mildly painful—4 out of 10 on a pain scale. His blood sugars have been high: 190 fasting in the morning and 290 before evening meal. His diet has not changed, although he has been less active the past week due to the swelling in his legs. He denies chest pain, cough, fever, hemoptysis, taking any over-the-counter medications, polyuria, polydipsia, and polyphagia.

Medical History

Diabetes mellitus (DM) type II for 5 years
Family History

His wife, children, and four living siblings have DM type II. His father and two brothers, now deceased, had hypertension and DM type II; causes of deaths are not known.

Medications

Metformin increased to 1 Gm bid 30 days month ago to bring his sugars down about 20 to 30 points in the morning and evening.

Allergies

None reported

Social History

Patient does not smoke or drink.

Physical Examination

Weight 225 lbs +10 pounds since his last visit 1 month ago, BMI 30

BP - 158/100, P - 100, T - 98, O2 sats - 94% room air at rest

S3 & S4 gallop, + JVD, bibasilar crackles, 3+ pitting edema.

The skin on his ankles to mid-calf is red, warm, slightly scaly, and tender to the touch.

Labs

TSH -5.2 (0.5- 4.5)
Free T4 - 0.8 (0.8-1.7)
Free T3 - 1.8 (2.0-4.8)

A1C - 9 (<5.7)
CBC
Hemoglobin - 12 (13.8 - 17.2)
Hematocrit - 38 (41 - 50)
RBC indices are normal
WBC - 12 (4.5 - 10.5)
BUN - 22 (7 - 20)
Creatinine - 0.6 (0.8 - 1.4)
Total cholesterol - 240
HDL - 35
LDL - 180
Triglycerides - 400

Radiology

Results of a recent chest X-ray are pending.

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