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Alterations in Cardiovascular Function

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Case 1 (Chapter 23: Alterations in Cardiovascular Function)
A.O. was an 89-year-old woman with a long history of heart failure secondary to a large left ventricular infarct. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She took digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin.

Discussion Questions
1.Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with this type of heart failure?
A.O. has left sided heart failure. Other clinical findings that present with left sided heart failure are pulmonary congestion and inadequate perfusion of the systemic circulation and symptoms include orthopnea, cough, fatigue and edema and decreased urine output. Pulmonary edema and S3 gallop (3rd heart sound) is present with the physical examination, as well as high or low blood pressure. An echo can show decreased cardiac output and a chest x-ray may show an enlarged heart (Huether & McCance, 2012).
2.What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output?
The cardiac output is dependent on the heart rate and stroke volume. The factors that affect heart rate are the central nervous system, autonomic nervous system, neural reflexes, atrial receptors and hormones. The factors that affect stroke volume are preload, afterload, myocardial contractility and heart rate.
As for the compensatory mechanisms in A.O’s case is the increased preload. It increases ventricular filling and increased ventricular end diastolic volume stretching the heart muscle beyond what it can handle and stroke volume declines. The decline in stroke volume

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