• Subject Name : Nursing

Health Variations

The medical history information concerning the patient reveals that she has encountered with heart failure and complaining of severe breathlessness that lead to admission to the emergency department. After the assessment, she has been recently diagnosed with the acute exacerbation of the chronic heart failure that has increased patient complication.


One of the clinical disorders that arise due to the structural and functional deformity in the myocardium that decrease the blood supplying capacity is considered to be the heart failure state. Different factors increase the chances to encounter heart failure includes hemodynamic overload, ventricular remodelling, abnormal myocyte calcium cycling and accelerated genetic mutation. There are different classes of the heart failure concerning with the part of the heart that has reduced functionality which includes left ventricular, right ventricular and biventricular. There is an increase chance of reoccurrence of the heart failure if the patient has encountered it early due to decrease strength of the myocardium (Inamdar & Inamdar, 2016).

Normally heart works in the rhythm that is important to pump the blood to different organs to maintain the demand and supply. The heart supplies the blood to the different organs by alternate systolic and diastolic processes that are required to gain the strength to supply the blood. During the heart failure state where the supply is not able to compensate for the demand of the blood that increases complication. The abnormalities in the structure of the heart occur due to decreased strength of the muscle unable the heart to pump the blood to different organs (Malik et al., 2020).

The heart failure leads to decrease cardiac output that results in the negative remodelling of the heart following worsening ventricular function. There are different staging for the heart failure that helps to understand the intensity of the issue and these grades are used to differentiate the patient. The stage starts from A that includes the patient with no structural disorder but at high risk to encounter heart failure. Stage B deal with the patients having structural deformity without any symptoms that indicate heart failure. Stage C includes patient having symptoms of heart failure and stage D includes patient with the end-stage disorder that needs urgent attention (Jarvis & Saman, 2017).

Different factors lead to the decreased strength of the myocardium which involved hypertension, valvular disorder and myocardial infraction that cause the pressure overload over the heart. The increases in pressure lead to greater cardiac works which cause increased wall stress. The persistent wall stress leads to cell stretch that leads hypertrophy indicated by increasing protein synthesis and fibrosis. The result is the cardiac dysfunction that is characterized by arrhythmias and neurohumoral stimulation (Katz, 2018).

This is the pathophysiology that is associated with heart failure and it leads to increase complication for the patient. These incidents increase the chances of the patient to face the heart failure that directly hamper the health status and reduce cardiac output capacity. This pathophysiology leads to the different sign and symptoms that are prominent in the patient and clinical manifestation is important to diagnose the patient encountered with heart failure.

Clinical Manifestation

The clinical manifestation related to heart failure includes different signs that are the first line of diagnosis for heart failure in the patient. Many clinical symptoms are related to the misbalance of the blood supply that occurs due to the decreased strength of the heart muscle leading to heart failure. Some of the symptoms include shortness of breath, crackle sound from lungs, increase blood pressure and tiredness. The misbalances of the blood supply to different organs increase the complexity due to the lack of oxygen that leads to the issue. One of the common issues faced by the heart failure patient includes shortness of breath that occurs due to lack of oxygen. Breathing and blood supply are closely related thus inefficiency to supply the blood leads to the breathing issue. The patient-facing shortness of breath should be immediately treated to reduce the complication that can occur due to breathing issue like cognitive impairment (Arrigo et al., 2016). Severe shortness of breath was also observed in the patient discussed in the case study.

The increase in blood pressure that is prevalent in the case study is one of the consequences of heart failure. This was also discussed by Udelson & Stevenson (2016) in their study that indicates that fluctuation in the blood pressure is the sign of heart failure but hypertension is a major complication. The increase in blood pressure is the result of the adrenaline rush in the body that occurs due to stressful condition. The adrenaline rush leads to the disturbance in the sympathetic nervous system that leads to a rise in the blood pressure. The rise in the blood pressure is a serious condition and thus patient should be immediately addressed with appropriate intervention to reduce risk.

Pulmonary edema is also common with a patient recently encountered with the heart failure that increases the complication. Patient facing pulmonary edema can be diagnosed with the lung auscultation sounds that resemble the bilateral basal crackles. When there is a lack of proper blood supply to different organs that result in the backflow of the blood that led causes multiple complications. The result of this is fluid fills in the air sacs cavity in the lungs that lead to the prognosis of the pulmonary edema. The ignored pulmonary edema can be life-threatening thus patient diagnosed with unusual lung sound should undergo a confirmatory test to provide accurate intervention (King & Goldstein, 2020). The patient in the case study have also diagnosed with the crackling sound that can be signed for the pulmonary edema that is a sign of the heart failure thus patient should be immediately treated to reduce complication.

This is the clinical manifestation that has been associated with the condition of the heart failure that is discussed in the case study concerning patient health status.

References for Mr. Brown Heart Failure Case Study

Arrigo, M., Parissis, J. T., Akiyama, E., Mebazaa, A. (2016). Understanding acute heart failure: Pathophysiology and diagnosis. European Heart Journal Supplements, 18(28), 11–18. DOI: 10.1093/eurheartj/suw044

Inamdar, A. A., & Inamdar, A. C. (2016). Heart failure: diagnosis, management and utilization. Journal of Clinical Medicine, 5(62), 1-28. DOI: 10.3390/jcm5070062

Jarvis, S., & Saman, S. (2017). Heart failure 1: Pathogenesis, presentation and diagnosis. Nursing Times, 113(9), 49-53.

Katz, S. D. (2018). Pathophysiology of chronic systolic heart failure. A view from the periphery. Annals of the American Thoracic Society, 15(Supplement_1), S38–S41. DOI: 10.1513/annalsats.201710-789kv

King, K. C., & Goldstein, S. (2020). Congestive heart failure and pulmonary edema. Treasure Island, United Kingdom: StatPearls Publishing.

Malik, A., Brito, D., & Chhabra, L. (2020). Congestive Heart Failure. Treasure Island, United Kingdom: StatPearls Publishing.

Udelson, J. E., & Stevenson, L. W. (2016). The future of heart failure diagnosis, therapy, and management. Circulation, 133(25), 2671–2686. DOI: 10.1161/CIRCULATIONAHA.116.023518

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