Systolic heart failure is congestive heart failure with reduced ejection fraction (HRrEF), less than 40%, and is defined as the inability of the heart to perfuse adequately to cell tissue, due to decreased cardiac output (McCance & Huether, 2019). Heart rate and stroke volume are influenced by contractility, preload, and afterload affecting cardiac output, and decreasing contractility with disturbances in myocyte activity. Ultimately, decreasing stroke volume and contractility while increasing left ventricular end-diastolic volume, and increasing preload.
Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF) can occur along with systolic heart failure, or alone, and is most commonly caused by persistent hypertension-induced myocardial hypertrophy, and myocardial ischemia causing ventricular remodeling along with higher diastolic pressure (Gazewood & Turner, 2017). Impaired relaxation is the result of decreased ability of myocytes to pump calcium from cytosol manifesting from ischemia and hypertrophy (McCance & Huether, 2019). As well as, decreased compliance of the left ventricle and abnormal diastolic relaxation. More common in females, patients with diastolic dysfunction present with dyspnea on exertion, fatigue, S3 heart sounds, and pulmonary edema
State whether the patient is in systolic or diastolic heart failure.
Due to the patient’s ejection fraction of 25%, the patient is in systolic heart failure. The clinical presentation of the patient also leads to systolic heart failure with the 3rd heart sound noted, commonly caused by atrial pressure, edema to the lower extremities caused by decreased cardiac output, dyspnea, and crackles as a result of pulmonary edema due to insufficient blood flow resulting in the congestion of blood in the lungs, as well as jugular vein distention. The patient’s past medical history of hypertension, hyperlipidemia, and type 2 diabetes contributes to the likelihood of systolic heart failure.
Explain the pathophysiology associated with each of the following symptoms
A common symptom of heart failure, shortness of breath occurs due to the decreased ability to maintain left ventricular pressure and contractility, resulting in chronic back pressure of blood into the left atrium with backflow into the pulmonary veins, creating elevated pressures in the vessels around the lung, and congestion in the lungs. Clinical presentation of this includes shortness of breath, anxiety, cough with blood-tinged mucus, and respiratory crackles on auscultation. Pitting edema in the lower extremities is caused by an excess fluid build-up, venous insufficiency, and the heart’s inability to pump blood throughout the body. In this patient’s case, with an ejection fraction of 25%, the left ventricle is unable to meet the demands of blood flow for the body, resulting in the pooling of blood and fluids in the lower extremities. Increased pressure in the right atrium results in backflow of blood flow manifesting as jugular vein distention. Similar to the shortness of breath that occurs during exertion, orthopnea is the presence of difficulty breathing while lying flat. The result of this is due to the backflow of blood into the lungs, as a result of a decreased ejection fraction and pulmonary congestion due to ventricular failure and increased filling (McCance & Huether, 2019).
Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%
Ejection fraction measures the percentage of blood that leaves your heart with every contraction, ejecting blood from each of the two ventricles (mayoclinic.org, n.d). The left ventricle is the body’s main pumping chamber, and as the ejection fraction decreases so does the heart’s ability to supply oxygen-rich blood through the aorta and to the rest of the body. An ejection fraction of lower than 40% or less results in ventricular heart failure. Abnormal or extra heart sounds reflect left ventricular dysfunction (McCance & Huether, 2019). The 3rd heart sound occurs in diastole at the end of the filling of the ventricles, as seen in heart failure patients due to rapid ventricular distention, and increased atrioventricular flow (Shono et al, 2019).