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ACUTE DECOMPENSATED HEART FAILURE, Gastroesophageal reflux disease (GERD),…

- - - - Hereditary
        
        Risk 🠕 if there's family history
        
        Heart disease tends to runs in families.
      - Gender
        
        HFpEF = Women
        HFrEF = Men
        
        Women have more severe symptoms > Men
        
        Men prone to develop at earlier age > women
        
        Women > Men in terms of developing diastolic heart failures
        
        Men > women in terms of risk having CHF
      - Age
        
        🠕 age, 🠕 risk
        
        walls of heart thicken + arteries stiffen = 🠓 heart's ability to pump blood to the body
        
        🠕 cardiovascular disease
    - - Sleep Apnea
        
        OSA seen in 40-50% of CHF patients
        
        Increased afterload
        hypoxia
        sympathetic nervous system activation
        
        put a strain on the left ventricle
        
        cumulative effects of 100s of obstructive apneas → development or worsening of LV heart failure.
      - Medication
        
        Some drugs might cause heart failure or other issues with the heart
        
        NSAIDs
        Neurological Drug
        Drug to treat blood pressure
      - Alcohol
        
        consuming more than a moderate amount of alcohol can lead to heart-related issues
        
        high blood pressure
        stroke
        irregular heartbeats
        weakening the heart muscle
        
        CHF
      - High Blood Cholesterol
        
        eat (meats, eggs, and dairy products) or heavy in saturated fat → extra cholesterol in body
        
        Plaque forms on artery walls
      - High Blood Pressure
        
        🠕 chances of developing heart disease, having a heart attack, or having a stroke
        
        Narrowed arteries that are less elastic make it more difficult for the blood to travel smoothly and easily throughout the body — causing the heart to work harder.
        
        CHF
      - Diabetes
        
        Most death in Diabetes patient due to CHF especially type 2.
        
        High blood sugar levels harm cardiac muscle cells over time
        
        cause the heart to work harder
        
        damage to tiny blood arteries throughout the body + in the heart
      - Obesity
        
        cause hemodynamic and myocardial alterations
        
        cardiac dysfunction
        
        additional body weight places a greater metabolic load on the heart
        
        fat cells in the abdomen may emit substances that are harmful to heart cells
        
        Lipid accumulation in the heart
      - Depression
        
        🠕 risk especially those with CAD
        
        🠓 motivation to maintain healthy daily routines
        
        Changes in the neurological system and hormonal balance
        
        🠕 prone for a cardiac rhythm disruption
        
        Women > Men in getting depression
      - Ischemic Cardiomyopathy(CM)
        
        Ischemic CM is the ability of heart to pump blood is decreased.
        
        Because heart's left ventricle is enlarged and weak
        
        How cause CHF? The coronary artery gets blocked completely by (blood clot/calcium/cholesterol)
        
        Blood supply to heart muscle cut off, Permanent scar and weaken heart muscle causing CHF
      - Coronary Artery Disease (CAD)
        
        CAD causes 🠓 flow of blood to the heart
        
        Arteries get blocked/narrowed
        
        The heart will starved Oxygen & nutrients
        
        This causes CHF
      - Osteoarthritis (OA)
        
        Osteoarthritis cause breakdown or joint
        
        Can cause inflammation
        
        Increase risk to heart failure
- - - - HTN, Diabetes Mellitus
      - Prolong used of certain drug such as aspirin and carvedilol
- - - - In relation to this case, it is noted that this patient has multiple comorbidities in her medical history, mainly hypertension, coronary artery disease (CAD), paroxysmal ventricular tachycardia, diabetes mellitus type II, obstructive sleep apnea, and dyslipidemia,
        
        In her past, there is a higher chance that torsemide use may cause greater disease severity in this patient, hence, may increase the risk of mortality and morbidity over a period of time.
        
        On the other hand, furosemide is generally considered as a standard medication of loop diuretics. Furosemide is more commonly used in heart failure patients due to its broad spectrum of pharmacological activity or clinical usefulness.
        
        Therefore, forusemide may be a safer drug of choice to treat this patient due to her current condition.
  - - - :fountain_pen: A potent loop diuretic drug
        :fountain_pen: Bioavailability (> 80%)
        :fountain_pen: Half-life (3-4 hours)
        :fountain_pen: Duration of therapeutic effect (6-16 hours)
    - - :fountain_pen: A potent and widely used loop diuretic drug
        :fountain_pen: Bioavailability (10-100%)
        :fountain_pen: Half-life (1.5-2.0 hours)
        :fountain_pen: Duration of therapeutic effect (6-8 hours)
- - - - blood builds up pressure and pushes the blood back to the lungs via pulmonary veins
        
        • Elevated pressures in the lungs blood vessels.
        • Increase perfusion, lead to edema
        
        increase the pulmonary airway resistance or obstructing the airway and interfere with gas exchange
        
        The edema the alveolar increases the pressure of the lungs, creating a pressure higher than atmospheric pressure.
        
        pressure gradients, the individual will have to breathe harder to force air into the lungs
    - - caused by a drastic increase in pressure in the lung’s blood vessels
      - when lie down, the blood from lower body circulates back to the heart much easier due to reduced gravitational pull
      - extra blood forced into the lungs, created additional pressure in the veins and capillaries will worsen the edema
  - - - blood starts to accumulate and build up back pressure, pushing it back into the vena cava then into body’s veins
        
        increases in venous pressure and perfusion, allowing fluids to seeps out into the surrounding tissue lead to edema at various parts of the body
    - - increase in backflow, increase pressure excerpted onto the vein
        
        deform the vein’s structure and impair the function of the valves. causes pooling of blood in the leg
    - - reduce blood flow supplying to the kidney, activates the renin-angiotensin system
        
        lead to increase peripheral resistance (vasoconstriction) and retention of sodium and water
        
        increase blood volume and worsen edema
  - - - change in splanchnic hemodynamic creates a mismatch between oxygen delivery and demand
        
        causes hypoperfusion and regional tissue hypoxia. Affecting enterocytes and intestinal smooth muscle function
        
        decrease water adsorption
        
        decrease peristalsis
    - - Further suppress the function of GIT and digestion
- - - - Mild cardiomegaly
        
        Cardiomegaly is seen in systolic dysfunction. The heart ventricle dilates and becomes unable to pump blood effectively in the quantity seen in the normal heart because of the inability to produce enough wall tension.
        Cardiac output decreases.
        The muscle fiber of the heart elongates excessively, causing it to contract more weakly.
        The ejection of blood becomes more difficult with the developed geometry of the enlarged heart. Less amount of blood (less than 40% to 50% of blood) in the ventricles is being pumped out/ ejected due to systolic dysfunction.
      - Last known ejection fraction of 25%
        
        The patient has a last known ejection fraction of 25% (from echocardiogram), which is low compared to the normal ejection fraction of between 50% to 70% of the left ventricle. This shows that the left ventricle’s contractile or systolic function is significantly reduced, indicating systolic dysfunction.
      - History of ischemic cardiomyopathy
        
        The myocardium is damaged due to ischemia developed from worsened coronary artery disease. Blood is blocked from being supplied to the myocardium, and consequently the heart muscle cannot get the required oxygen and nutrients and other metabolic needs. Cell death, fibrosis therefore occur, and the left ventricle enlarges and dilates. The systolic function of the left ventricle is greatly weakened in ischemic cardiomyopathy that the Left Ventricular Ejection Fraction (LVEF) reduces to below 40%, which is seen in this patient. Systolic dysfunction is a complication of ischemic cardiomyopathy.