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Group 4 Lynn and Renee 1 Cardiovascular and Lymphatic System Atrial Fibrillation/ Congestive Heart Failure Mrs. G has come for a follow up appointment after a diagnosis of new atrial fibrillation and congestive heart failure. Comorbidities include hypothyroidism which was found to be inadequately treated while in hospital 2 weeks ago. On examination she has inspiratory basal crackles bilaterally and pitting edema to her ankles and feet, in other words an exacerbation of CHF. You discover with your history she has stopped taking her water pill as she has to void too frequently at night. Pathophysiology Heart failure is a general term for many kinds of cardiac dysfunction resulting in inadequate perfusion to tissues, most arising from left ventricle dysfunction and categorized as either systolic or diastolic heart failure (McCance & Huether, 2006). Systolic heart failure occurs when there is an inability of the heart to provide enough cardiac output (CO) to perfuse vital tissues, CO is dependent on heart rate and stroke volume (McCance & Huether). AS Co falls, renal perfusion slows and activates the rennin-angiotensin-aldosterone system increasing peripheral vascular resistance (PVR) and plasma volume further affecting CO (McCance & Huether). Diastolic failure is defined as “pulmonary congestion despite a normal stroke volume and cardiac output” (McCance & Huether, pg. 1132). Results are the clinical manifestations of dyspnea, orthopnea, cough with frothy sputum, edema, fatigue, and decreased urinary output (McCance & Huether). Exacerbating Factors The major causes of heart failure are coronary artery disease, hypertension, and diabetes although cardiomyopathy, valvular disease, arrhythmias, viral infections, anemia, congenital heart defects, cancer treatments, thyroid disorders, alcohol abuse, HIV/AIDS, and cocaine and other illegal Group 4 Lynn and Renee 2 drug use can also cause heart failure (nhlbi.nih.gov, 2007; Canadian CHF clinics network, 2007). Based on the case study information provided, her hypothyroidism and atrial fibrillation are most likely the major contributing factors most certainly compounded by the discontinuation of her diuretic. Her hypothyroidism will decrease her stroke volume and heart decreasing her CO and can also increase her PVR as well as decreasing renal perfusion decreasing renal excretion of water (McCance & Huether, 2007). The arrhythmia can affect her preload by eliminating the atrial kick from ventricular filling, and the excess circulating volume related to the cessation of her diuretic will all contribute to the exacerbation of her CHF. References Canadian CHF Clinics Network. (2007). Pathophysiology of heart failure – information for health professionals. Retrieved on October 20, 2007 from http://www.cchfcn.org/nonmembers/english/0021/Emanual52.htm National Heart Lung and Blood Institute. (2007). What is heart failure? Retrieved on October 20, 2007 from www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_All.html McCance, K. & Huether, S. (2006). Pathophysiology the biologic basis disease in adults and children (5th ed.). Elsevier Mosby: St. Louis., Missouri.