Case Study 2
A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. 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 is being treated with 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 left-sided heart failure?
The type of heart failure usually associated with dyspnea is left-sided. Other clinical findings likely to be present with left-sided heart failure are cardiomegaly and pulmonary congestion such as orthopnea or basilar crackles. There would also be an increased heart rate and S3 heart sound while listening with a stethoscope.

2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output?
The following compensatory mechanisms are likely to be operative to enhance cardiac output: myocardial hypertrophy due to prolonged stretch on the myocardium; baroreceptors will detect a low blood pressure and carbon monoxide levels, which would excite the sympathetic system due to an increased heart rate. During this mechanism the beta receptors will downregulate; there would also be a decrease in the filtration rate of the glomeruli, and it will retain less water and result in increased preload.
3. What is the most likely cause of A.O.’s pedal edema?
The most likely cause of A.O.’s pedal edema is heart failure on the right side due to the left side failure causing pressure on the right ventricle, as well as biventricular failure
4. What