significant deterioration of health with acute

AF TO CHE
This assessment intends to explore management of an acutely ill 67-year-old man (Mr.X) who has
significant deterioration of health with acute shortness of breath from Congestive heart failure (CHF)
and associated Atrial fibrillation. Mr. X has history of chronic heart failure, type 2 Diabetes mellitus
(T2DM), hypertension (HTN), Atrial Fibrillation (AF) and is current smoker and has history of alcohol
abuse. On examination he was cold and clammy, with vitals showing hypotension of 80/45mmhg,
Tachycardia with irregular heart rhythm, Atrial Fibrillation of rate 112beats/min, respiratory rate 26
with increased work of breathing. He had significant edema on his lower limbs and exercise
tolerance was limited to only moving around his bedside with worsening work of breathing. He was
non-compliant with his medical management at home and was poorly following his fluid restriction
on this admission.
Congestive heart failure is defined as the inability of the heart to pump enough blood to meet the
requirements of the body. This is caused by different abnormalities in cardiac functions like loss of
cardiac muscle contractility, changes in blood pressure and blood volume, increased peripheral
demand (Gary S. Francis and Gary S. Francis, 2003). Mr X has significant risk factors to exacerbate his
CHF. This includes long term use of alcohol. Chronic use of alcohol can result in structural and
functional impairment of myocardial cells leading to heart failure (Sahle et al., 2018). He also has
history of diabetes.

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