Question

Chief Complaint: 74-year-old woman with shortness of breath and swelling.

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.

On physical examination, Martha's jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra, "S₃" heart sound.

9. What is the general term describing Martha's condition?

10. How might Martha's body compensate for the above condition?

11. Martha is started on a medication called digoxin. Why was she given this medication, and how does it work?

12. Two weeks after starting digoxin, Martha returns to the physician's office for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic called furosemide (or "Lasix"). Why was she given this

Answer 1

9. The general term describing Martha’s condition is congestive heart failure. It typically occurs when blood isn’t pumping normally. Narrowed arteries and high blood pressure are causative factors.

10. As Martha’s heart is not pumping blood normally , weakning her heart muscles. heart chambers might become stiff or thick leading to excessive swelling in her ankles because her kidneys are reacting causing her body to hold onto more water and salt.

11. Digoxin is used to treat irregular heart beats and treat heart failure as well. It works by acting on specific minerals inside heart cells thereby reduces strain on the heart . So Martha was given digoxin so that she could try to improve the strength and use of her heart.