Congestive Heart Failure Case - Assignment Example

The patient is experiencing a low-pitched murmur due to congestive heart failure. The patient had an extra S3 heart sound. This is due to a murmur heard after the initial heartbeat that ends ahead of the subsequent heart sound (Kouchoukos, 2012).

The stress placed upon the patient’s heart
The term which accurately describes the stress placed upon the patient’s heart is increased after load. This term refers to the increased cardiac output. The dysfunctional valve is unable to close fully thus permitting blood to seep back to the chamber it was recently. Continual seepage action may bring about a clot in the heart resulting in cases of stroke or pulmonary embolism. There is an increase in forward flow across the valve and a decrease in the aortic valve area. The cardiac output determines the discharge coefficients of the valve area. The pressure gradient is applied across the heart valves. The left ventricle is put under a lot of pressure as more vigor is needed to emit blood via the tight valve. There is resistance to the blood flow; leading to stress upon the left ventricular. Valvular dysfunction leads to no reimbursement with elevated end-diastolic pressure (Rajamannan, 2013). Valve dysfunction leads to the production of pressure overload caused by confined openings or volume overload by improper closing. Because of augmented pressure in the pulmonary system, congestive heart failure will be the result (Porth, & Porth, 2011).

How the body might compensate for the heart stress
Because of the stress imposed on the heart, by the dysfunctional ventricular; the body comes up with ways how to compensate for this chaos. The initial compensation is the thickening of the walls of the left ventricle. This is done to make up for the poor pumping action of the heart. Compensation for cardiac enlargement is seen in patients suffering from heart failure caused by valve dysfunction. Because of the narrowing action of the affected valve, there is evidence of calcification. Severe cases of valve dysfunction lead to congestive heart failure and other heart-related complications. Enlargement of the heart and thickening of the valves leads to the loss of performance and elasticity. Advanced cases of congestive heart failure lead to an enlarged right atrium and right ventricle depressing the systolic function (Rajamannan, 2013).

Does the cardiac silhouette rule out possible problems with the patient’s heart?
In chest radiography, cardiac size is normal in all patients who have valvular dysfunction. This is evident from the rounding of the left ventricular border and apex caused by hypertrophy (Henein et al, 2012). A chest x-ray showing normal results of a cardiac silhouette does not rule out a possible problem with the patient’s heart. Further examination procedures have to be carried out so that the condition of the patient can be determined. Although the chest x-ray shows normal results, the medical practitioner must still examine the heart based on the following questions. Why is an extra “S3” sound heard? Why is there a low-pitched rumbling systolic murmur? This means that there is a problem with the heart of the patient, and other tests must be done. A chest X-ray can not rule out any possible problem with the heart. Dysfunctional valves result in the commencement of other diseases. For instance, dysfunctional valves are prone to infective endocarditic diseases. Appropriate investigations that can determine any problem with the heart of the patient include; ECG, CXR, MSCT, and cardiac magnetic resonance, among many more (Otto, 2012).

The pathophysiological concept of the case study

Valvular heart dysfunction builds up from progressive narrowing and hardening of the heart valves. The valves mostly affected by these diseases are the aortic and mitral valves. Narrowing of the valves leads to inadequate pumping of blood which results to pressure increase on the left ventricle. This affects the contraction and expansion functions. The left ventricle acclimatizes to the impediment by thickening its walls and upholding the normal left ventricular chamber dimension. Hypertrophy is a mechanism to compensate for the stress exerted on the heart. Left ventricular systolic function and cardiac output are maintained despite the pressure gradient transversely experienced by the aortic valve. This mechanism cannot be permanently maintained, systolic function declines due to pressure overload. The left ventricle worsens and the diastolic pressure increase even though the ventricular size will be regular. There will be increased wall thickness resulting in decreased coronary artery blood flow and reserve. Symptoms develop at this point (McCance, & Huether, 2009). Read More