Dose-Ranging Hemodynamic Study

Acute heart failure is a heterogeneous syndrome which worsens the heart and requires therapy on urgent basis (McMurray et al., 2012).  From the pathophysiological view, the important reason for the heart failure is heart dysfunction along with pulmonary and systemic vasculature. These failures cause an increase in the workload which would produce neurohormonal, cellular and hemodynamic changes. Since Mrs. Brown was diagnosed acute exacerbation of heart failure (AEHF), so her systolic and diastolic dysfunction parameters were analyzed for her heart failure. The systolic dysfunction occurs due to the pumping problem which prevents the left ventricle for adequate pumping.   A defect in impaired ventricular contractility and increased workload comes under systolic dysfunction. Myocardial infarction and overload of chronic volume triggered auscultation crackles in the lung of Mrs. Brown. The high blood pressure of Mrs. Brown might be due to increased workload. A defect in the ventricular relaxation and ventricular filling are the major parameters of diastolic dysfunction. This two-factor leads to ventricular hypertrophy and pericardial constriction in the left ventricle of Mrs. Brown (Simonneau et al., 2012)

The pathophysiological causes of each of the clinical manifestations of Mrs. Brown could be understood by taking into account the systolic and diastolic dysfunction of heart failure.

Mrs. Brown complained of Dyspnea or shortness of breath which might be due to high pressure from pulmonary capillary from the left side of the heart which causes the retention of the fluid in the pulmonary interstitium. This could lead to decreased pulmonary flow and increased airway resistance. This may also lead to frothy sputum which could be due to pulmonary congestion and rupture in the bronchial veins which could lead to hemoptysis.

The auscultations present at the base of the lungs of Mrs.  Brown is the opening of small air passages which has been closed by interstitial edema. These openings are initially present at the base of the lung but as the condition of the heart worsens, so the pulmonary edema also worsens and it leads to the shifting of its position to a higher level and thus this sound is heard. Then it was seen that Mrs. Brown was having some problems with spatial oxygen, and the reason behind this was the high pressures of the pulmonary vascular which was due to the elevation in the pressure filling of left heart (Guest, 2015). The pulse rate of Mrs. Brown was due to the sign of ventricular dysfunction. Mrs. Brown complained of low respiratory rate also, and the reason behind this may be due to the initial myocardial infarction resulting from CAD (Bonderman et al.,2013). This leads to the high-pressure filling and poor or very low cardiac output. This low level of respiratory rate could also be due to the reduced delivery of oxygen to the peripheral tissues. The acute heart failure of Mrs. Brown could be well understood on the hemodynamic parameters and pressure- volume relationships of the left ventricle.

After seeing the clinical manifestations of Mrs. Brown, the above pathogenesis could be cited for each manifestation.

References:

Bonderman, D., Ghio, S., Felix, S. B., Ghofrani, H. A., Michelakis, E. D., Mitrovic, V., ... & Semigran, M. J. (2013). Riociguat for patients with pulmonary hypertension due to systolic left ventricular dysfunction: a phase IIb double-blind, randomized, placebo-controlled, dose-ranging hemodynamic study. Circulation, CIRCULATIONAHA-113.

Guest, W. (2015). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. Internal Medicine.

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.

Simonneau, G., Gatzoulis, M. A., Adatia, I., Celermajer, D., Denton, C., Ghofrani, A., ... & Olschewski, H. (2013). Updated clinical classification of pulmonary hypertension. Journal of the American College of Cardiology,62(25), D34-D41.

MyAssignmenthelp.co.uk is a name in assignment writing services that students trust. We offer our assignment writing services for a wide variety of assignment including essays, dissertations, case studies and more. Students can place their order with us anytime as we function 24x7, and get their copies at unbeatable prices. We guarantee that all of our solutions are plagiarism-free.