• 1) According to the ACC/AHA Guidelines,
ACC/AHA 2017 guideline places ML at stage C heart failure (Yancy et al., 2017). Pertinent positives to
... [Show More] classifying ML at stage C are:
HPI: 72-year-old AA, female c/o SOB for the last two months, SOB is worse with activity, wakes her up at night, resolved with using 3 pillows, reports lower leg edema, feels lightheaded and faint when going up the stairs
PMH: HTN, MI in 2010- cardiac stent placement in 2010
Family Hx: father died of a heart attack; one brother died of a heart attack
ROS: lightheaded and faint with exertion. Shortness of breath with exertion + Orthopnea + leg and ankle swelling x 1 week. Non-compliant with medications for the last 6 months.
Physical: Obese, BP 148/86, inspiratory crackles, S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids. 2+ pitting edema to her knees noted bilaterally.
Echo- LVEF 39% moderate dysfunction (American College of Cardiology, 2019)
BNP - 682 pg/ml – (Liu et al., 2015)
2) According to the ACC/AHA Guidelines,
The goal for ML is to decrease preload and afterload to reduce s/s of HF. Along with improving patient’s survival rates (Inamdar & Inamdar, 2016). I will be monitoring ML very carefully according to Yancy, 2017 patients should be started on the lower doses and increased as needed or for symptom relief.
Losartan-ARB- The rationale of prescribing an ARB is to improve the survival rate by causing vasodilation by neurohormonal modification (Yancy et al., 2017). The reason for me to start with an ARB is that since ML is AA and already non-complaint most patients who are on an ACE inhibitor may have unwanted side effects such as a cough and angioedema.
Metoprolol succinate-Beta blockers- help control the ventricular rate and prevent arrhythmias by also providing neurohormonal modifications (Yancy et al., 2017).
Spironolactone-Diuretics- The reason for prescribing a diuretic is to reduce fluid volume, but doing this it will help reduce the edema in her lower legs and provide symptom relief (Bahit, Kockar, & Granger, 2018)
3) Given the patient’s history of MI
Aspirin-Antiplatelet therapy- aspirin is used to thin the blood to prevent blood clots from forming which can lead to a heart attack or a stroke (Switaj, Christensen, & Brewer, 2017)
Lipitor- HMG-COA reductase inhibitor (statin)This is to reduce atherosclerosis from building up on the vessel’s walls (Switaj, Christensen, & Brewer, 2017)
4) Write the complete prescriptions using the prescription writing format. [Show Less]