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15Mar 2022 by
First peer response….. Please respond to this 2 post and not the samples…..Professor and class, Differentiate between systolic and diastolic heart failureZhang et al (2019) describe heart failure as the heart’s inability to transport enough blood to meet the body’s demand at normal filling pressures resulting in a complex and severe disease syndrome. Systolic heart failure is referred to as heart failure with reduced ejection fraction HFrEF. This occurs when the heart’s ejection fraction pumps below 45% ( McCance & Huether, 2019). According to Zhang et al (2019), HFrEF results from cell death due to lack of oxygen and nutrients to the cell as well as the build up of metabolites from cell processes. Diastolic heart failure HFpEF occurs due to fibrosis and decreased ventricular compliance along with ventricular relaxation ( Zhang et al 20219). Heart failure with preserved ejection fraction is pulmonary congestion in the presence of a normal stroke volume and normal cardiac output (McCance & Huether, 2019). The American Heart Association, in an article written by Pfeffer et al (2019) defined HFpEF as those individuals who have heart failure with an ejection fraction in the midrange of 40% but below 50% ( Pfeffer et al., 2019).State whether the patient is in systolic or diastolic heart failureI believe that the patient is in systolic heart failure HFrEF because of the result of his echocardiogram showing an ejection fraction of 25%. Moreover, the patient has two other medical history that puts him at risk for this type of heart failure; hypertension and type 2 diabetes. He also has a new diagnosis of MI which is the most common cause of decreased contractility ( McCance & Huether, 2019). Furthermore, individuals with HFrEF or systolic heart failure will present with crackles, dyspnea and S3 gallop ( McCance & Huether, 2019).Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.As a result of the decrease in contractility due to presence of MI, an inflammatory response results from the release of neurohumoral activation (McCance & Huether, 2019). The neurohumoral activation releases a cascade of sympathetic nervous system (SNS) and renin angiotensin aldosterone system (RAAS). The kidneys retain sodium and water (McCance & Huether, 2019). The combined activation of the system leads to ventricular remodeling which further weakens the heart’s ability to maintain adequate contractility (McCance & Huether, 2019). As a result, stroke volume decreases while there is an increase in left ventricular end-diastolic volume (LVEDV), leading to an increase in preload (McCance& Huether, 2019). The combination of increase in preload and the heart’s inability to contract effectively, diminishes the supply to the kidneys exacerbating the RAAS and SNS response (McCance & Huether, 2019). The increasing preload results in a lack of adequate blood supply to the body and diminished oxygen which leads to dyspnea on exertion. Pitting edema results as part of the cascade of hormone release. Arginine vasopressin causes both peripheral vasoconstriction and retention of renal fluid resulting in edema (McCance & Huether, 2019). The inadequate pumping action of the heart results in low blood pressure, forcing the heart to pump harder to meet demand as evidenced by distended jugular distension and a low BP of 106/74 and an elevated HR 110 bpm. Decreased contractility of the heart leads to peripheral vascular resistance associated with vaso-congestion (McCance & Huether, 2019), this action is evidenced by fluid build up in the lower extremities of heart failure patients. When patients with heart failure attempt to lie down, the accumulated fluid in the legs returns into circulation thereby resulting in overload and shortness of breath.Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%.The 3rd heart sound, ventricular gallop, occurs after S2 when the atrioventricular valves open and blood flows rapidly from the atria into the left ventricle (Higgins, 2019). Calcium transport into, out of and into the myocytes is impaired due to changes in the intracellular transport mechanisms. This causes a decrease in myocardial contractility and the heart resulting in a decreased ejection fraction ( McCance & Huether, 2019). A patient with decreased ejection fraction will be very weak and fatigued from lack of oxygen perfusion. They often present with limited activity tolerance.Mercy Akpan 
References: McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biological basis for          Diseases in adults and children (8th ed.). Elsevier Health Sciences. Higgins, J. P. (2019). Physical Examination of the cardiovascular system. International          Journal of the Clinical Cardiology. https://www.doi:10.23937/2378-2951/1410019. Pfeffer, M. A., Shah, A. M. & Borlaug, B. A. (2019). Heart Failure with Preserved Ejection          Fraction In Perspective. https://www.doi:org/10.1161/CIRCRESAHA.119.313572.  Zhang, Y., Bauersachs, J. & Langer, H. F. (2017). Immune mechanisms in heart failure          European Society of Cardiology. .
Second peer postDr. Baez,Individuals who present to their primary office in heart failure can present clinical manifestations of different types, which can help determine systolic or diastolic heart failure diagnosis. Therefore, a proper evaluation and extensive workup are essential for diagnosing precipitating factors, comorbidities, and cardiac disorders. Although some symptoms that a patient presents with can be the same as other comorbidities and resemble different heart failures, the proper diagnosis is imperative. Heart failure is a presence of cardiac abnormalities, and symptoms that correlate with heart failure are dyspnea upon exertion or at rest, orthopnea, tiredness, peripheral edema, JVD, crackles bi-laterally in the bases, and the S3 heart sound. Specific symptoms can help the provider determine whether the patient is experiencing systolic or diastolic heart failure. Further imaging and cardiac labs are necessary for an accurate diagnosis and the patient’s symptoms; lung ultrasonography can help determine pulmonary congestion’s significance by showing interstitial fluid evidence. Electrocardiograms can show evidence of arrhythmias, heart function, and size, and monitoring of troponins can show previous heart damage by MI and BNP, a marker for heart failure (Arrigo et al., 2020).The presenting crackles can be evidence of systolic or diastolic heart failure, clinical findings of dyspnea on exertion, fatigue, an S4 gallop, and a history of current comorbidities, along with evidence of preserved ejection fraction, diastolic dysfunction, and enlargement of the left atrial can indicate diastolic heart failure. In addition, for further evidence and an accurate diagnosis, an examination with an echocardiogram can validate insufficient filling of the ventricular, abnormal relaxation, hypertrophy, and, lastly, a chest x-ray that will show pulmonary congestion. Systolic heart failure has a reduced ejection fraction, S3 gallop, orthopnea, and fatigue. For further evaluation, troponin serum and an ECG can validate ischemia, a chest x-ray can verify the heart size and pulmonary congestion, and an echo shows the decrease in cardiac output and cardiomegaly that correlates with systolic heart failure (McCance & Huether, 2019). Arrigo, M., Jessup, M., Mullens, W., Reza, N., Shah, A. M., Sliwa, K., & Mebazaa, A. (2020, March 5). Acute heart failure. Nature News. Retrieved March 11, 2022, from https://www.nature.com/articles/s41572-020-0151-7McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biological basis for          Diseases in adults and children (8th ed.). Elsevier Health Sciences.
Sample post FIRST SAMPLE Hi Carolyn,I have to admit I did not dedicate enough of my attention to the additional heart sound during my initial post on Wednesday. You’ve explained it in a clear and concise manner which I really appreciate. In researching the third heart sound and mitral valve regurgitation I came upon a clinical trial that was exploring the hospital admission rate of individuals in heart failure presenting with a third heart sound, as they believed that those experiencing a specific type of third heart sound based on the measurement of their S3 heart sound are more apt to require additional interventions, and thus should be provided with increased surveillance to mitigate lethal complications (Boehmer, J., Milton S. 2019). Given the clinical implications of the development of the third heart sound and advancement of heart failure, being more aware of those who are likely to require advanced intervention before an event takes place could greatly improve longevity and quality of life. Reference:Boehmer, J., Milton S. (2019). Electronic S3 Prediction of Hospital Readmissions for HF Exacerbation. Case Medical Research. https://doi.org/10.31525/ct1-nct04112849SECOND SAMPLE
TuesdayMar 8 at 12:27pm
Dear Logan,Nowadays, a great majority of diagnoses are made relying on the results of exams. However, the medical interview and physical exams should never be forgotten.Question: Would it be possible to clinically differentiate a right sided from a left sided heart failure? Explain your answer.Please, contact me if you need my help at any time!Dr. R.
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YesterdayMar 11 at 7:39am
Dr. Rodriguez-Baez,Assuming that the patient is experiencing an early heart failure exacerbation, a patient exhibiting left-sided heart failure may experience a cough, shortness of breath, and orthopnea secondary to the backup of blood in the pulmonary vasculature. In contrast, patients with right-heart failure may experience peripheral dependent edema manifesting in swollen extremities, often with the most severe edema being at the lowest point of gravity (IQWiG, 2018).Prolonged exacerbation can be challenging to diagnose clinically as the cardiovascular system becomes increasingly overloaded. Patients whom are noncompliant with treatment (intentionally or not) could progress to biventricular heart failure and multi-organ system failure. I have cared for a few CHF patients in the ICU who were so fluid overloaded that they required mechanical ventilation and continuous diuretic infusion or even continuous renal replacement therapy (CRRT) to decrease the fluid burden.Thank you for our discussion prompt.Sincerely, Logan LandmannReferencesInstitute for Quality and Efficiency in Health Care. (2018). Types of Heart Failure. Retrieved March 11, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK481485/

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