Congestive Heart Failure
Clinical Case Study
• A 61-year old man enters the emergency room with acute
shortness of breath, rapid and noisy wheezing, a productive
cough, dyspnea, cyanosis, dysrhythmias, elevated blood
pressure, and dizziness.
• You administer an EKG, order a chest X-ray, and run an
• His tests reveal pulmonary edema, hepatomegaly, renal
insufficiency, and severe electrolyte imbalances.
Diagnosis of the Patient
• Congestive Heart Failure
The heart is weakened and cannot efficiently meet the
needs for the rest of the body.
Causes of Patient’s Symptoms
CHF symptoms may be mild to severe. Symptoms can be constant or
intermittent and can include:
• Rapid & Noisy Wheezing & Productive Cough: This is lung congestion
in which fluid backs up into the lungs which occurs when the heart is unable
to efficiently pump enough blood out.
• Dyspnea: is shortness of breath which can occur when exercising or while
resting or when lying flat in bed.
• Cyanosis: is bluing of the skin and mucus membranes. This occurs when
there is insufficient oxygen in the blood which often occurs when the lungs
and heart pump are compromised.
• Dysrhythmias (Heart Arrhythmia): is when the electrical impulses in
the heart that coordinate heartbeats are not working properly. This causes
the heart to either beat too slow (bradycardia), beat too fast (tachycardia),
or beat irregularly which can result in dizziness.
• Elevated Blood Pressure: is due to the heart overworking itself.
• Pulmonary Edema: is a condition caused by excess fluid in the
lungs. Instead of air, fluid collects in the numerous air sacs (the
alveoli) in the lungs, making it difficult to breathe and preventing
oxygen from being absorbed into the bloodstream.
• Hepatomegaly: is an enlarged liver but is not a disease. It is a sign
of an underlying problem, such as liver disease, congestive heart
failure or cancer.
• Renal insufficiency: aka Kidney Failure is when the kidneys no
longer have sufficient ability to carry out their normal functions.
• Severe Electrolyte imbalances: are caused by a deficiency or an
overabundance of minerals in the body. For example, excessive
amounts of potassium and calcium can disrupt the overall balance
and functioning of the nerves, cardiovascular system, and muscles.
What is CHF?
Heart failure affects nearly 6 million Americans. It is the leading cause of
hospitalization in people older than 65.
• Heart failure, sometimes known as congestive heart failure (CHF), occurs when your
heart muscle doesn't pump blood as well as it should.
• When the heart’s pumping power is weaker than normal
Blood moves through the heart and body at a slower rate, and pressure in the
• When the heart cannot pump enough oxygen and nutrients to meet the
The chambers of the heart may respond by stretching to hold more blood to
pump through the body or by becoming stiff and thickened.
This helps to keep the blood moving, but the heart muscle walls may eventually
weaken and become unable to pump as efficiently.
• The kidneys may respond by causing the body to retain fluid (water) and
If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body
becomes congested. This condition is referred to as congestive heart failure.
Possible Complications of CHF
• Heart valve problems. The valves in the heart keep blood
flowing in the proper direction but when they malfunction the
heart may become enlarged or it may create pressure in the
• Liver damage. Heart failure can lead to a buildup of fluid
that puts too much pressure on the liver. This fluid backup can
lead to scarring, which makes it more difficult for your liver to
• Stroke. This occurs when the blood flow through the heart is
slower than in a normal heart, the development of blood clots
can increase, which in turn can increase the risk of having a
• Death!!! If left untreated.
• Do not smoke, use tobacco products, or drink alcohol.
• Eat a healthy diet.
• Exercise regularly.
• Do not overdo it.
• Recognize signs of decompensation.
• Take your medications as prescribed.
• Get emotional or psychological support.
Although surgery is more risky for people with heart failure, with advancing
technology surgery reduces the risks and improves the patient’s outcomes.
• Coronary artery bypass grafting surgery – (Most Common)
• Heart Valve Surgery
• Implantable left ventricular assist device (LVAD)
• Heart Transplant
• For the Renal Insufficiency, he will need to go on dialysis and possibly get a
• The prognosis looks promising!
• However, the patient’s future will depend on how well the heart
muscle is functioning, the symptoms, and how well the patient
responds to the treatment plan.
The patient needs to follow all the treatments prescribed.
The patient should get a "living will” that expresses his desires
about the use of medical treatments to prolong his life.
This document should be prepared while he is fully competent in
case he is unable to make these decisions at a later time.
• With the right care, CHF will not stop the patient from doing the
things he enjoys and having a better lifestyle.
• American Association for Clinical Chemistry. (2001-2014). Lab Tests Online, Electrolytes. Retrieved from:
• (Beardwood, Norma, MBA, M.Ed., RDN, LD, LPC, CEDS, personal communication, March 13, 2014).
• Haines, Cynthia, M.D. (2013). Electrolyte Imbalance. Better Medicine from healthgrades. Retrieved from
• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Enlarged Liver. Retrieved
• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Heart Arrhythmia.
Retrieved from http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/basics/symptoms/con-
• Mayo Foundation for Medical Education and Research. (2014). Diseases and Conditions, Heart Failure. Retrieved
• Mayo Foundation for Medical Education and Research. (2014). Tests and Procedures, Chest X-Rays. Retrieved from
• Mayo Foundation for Medical Education and Research. (2014). Tests and Procedures, Electrocardiogram. Retrieved
• Renal Insufficiency (n.d.). In Kidney Problems online. Retrieved from http://www.kidney-problem.org/renal-
• Stöppler, Melissa Conrad, M.D. (2012). Medicine Net. Cyanosis/Turning Blue. Retrieved from
• WebMD. (2005-2014). Medicine Net, Valve Disease Treatment (Heart Valve Surgery). Retrieved from
• WebMD. (2005-2014). Heart Disease Health Center, Heart Disease and Congestive Heart Failure. Retrieved from
• Yahoo.com. (n.d.). Retrieved from http://images.search.yahoo.com/yhs/search;_ylt= A86.J777aFFT6x8AoXUPxQt.;