The case of a 79-year-old man with a history of hypertension and Stage B heart failure will be discussed. Hypertension, myocardial infarction, and heart failure are the three differential diagnoses given to the patient regarding his main complaints which are shortness of breath, swelling in his legs, and a history of myocardial infarction.
Uncontrolled/essential/primary hypertension (I10) is a condition that is characterized by high blood pressure. It may develop gradually with no evident causes for many years (Banegas et al., 2014). Though no secondary causes are observed, certain risk factors should be mentioned, including stress, diet, and obesity. Genetic factors play a serious role and determine a disposition for this disease. This diagnosis is given because the patient’s blood pressure is 170/95. It is high regarding normal respirations (22 beats) and a heart rate (88 beats).
Heart failure, unspecified (I50.9) is a condition that occurs as soon as the heart cannot pump blood and meet all body’s needs. This disease usually occurs as a result of a damaged heart muscle. This muscle may be damaged because of the wrong work of kidneys, anemia, or inflammation. Heart failure may also be caused by hypertension, smoking, or diabetes (Go et al., 2014). Due to extensive overloading caused by a new disease, the heart becomes unable to cope with pressure and fails. The patient’s history of myocardial infarction and high blood pressure at the moment of addressing the hospital are the main causes of this diagnosis.
Myocardial infarction, also known as heart attack, (I21.9) is a condition when blood flow decreases or stops working (Bonaca et al., 2015). Atherosclerosis is a primary cause of myocardial infarction in most cases. The causes of myocardial infarction may be of two types: modifiable and non-modifiable. Old age, sex, and a family history of the disease are the main non-modifiable risks. Smoking, high blood pressure history, a high cholesterol level, and obesity are the modifiable causes of this disease that should be mentioned. This disease was already observed in the patient. Therefore, this diagnosis is given regarding current complaints and health problems.
Hypertension is characterized by blood pressure elevation. Increased cardiac output and increased total peripheral vascular resistance are observed. A patient is a 79-year-old man with a history of myocardial infarction. He is at risk of having an increased stiffness that influences pulse pressure.
Cardiac dysfunction leads to changes in vascular function, blood volume, and neurohumoral status causing heart failure (Tanai & Frantz, 2015). Norepinephrine is released and promotes the work of the sympathetic nervous system that influences arterial pressure.
Myocardial infarction has a form of myocardial necrosis and the occlusion of an epicardial artery. The heart performs one of the main functions in the body that is transferring oxygen and other important nutrients. As soon as the heart stops performing this function, an imbalance occurs causing a number of harmful biochemical and inflammatory events.
Epidemiology of the Diagnosis
Approximately 68 million Americans suffer from hypertension (Banegas et al., 2014). The cases of hypertension can be increased with age. Gender is a factor that does not play a crucial role because old men and women are exposed to having hypertension in almost equal parts. Heart failure is a disease that affects 6 million Americans of different ages. Still, patients older than 65 years are diagnosed with heart failure more frequently in comparison to younger patients. Black Americans introduce a group of people who are at risk of having this disease. Myocardial infarction is the cause of hospitalization of 6 people per 100 annually. The number of cases of myocardial infarction increases annually. As a rule, patients older than 35 years are exposed to having such problems with the heart that cause myocardial infarction.
A history of myocardial infarction is used to confirm the diagnosis. Hypertension is proved by high pressure. To confirm the diagnoses, an ECG and blood tests should be taken. Additionally, chest X-ray images can be used to check the peculiarities of blood vessels and clarify what kind of problem occurs (Woo & Wynne, 2011). The results of ECG and chest X-rays can be used to clarify all clinical features and conclude what exact problem occurs.
Goals of Drug Therapy
Drug therapy for all three diagnoses given includes the prevention of the rise of blood pressure, the intention to restore the work of blood flow, the necessity to control the heart rhythm. In some cases, patients may ask to relieve chest pain. Finally, all drugs and recommendations should be followed carefully not to cause a new heart attack or other problems with the heart.
Prescriptions for Medications
In the case of a 79-year-old man with a history of myocardial infarction, his current medications, including Carvedilol and Lisinopril have to be removed. A new beta-blocker should be recommended in order to control the condition of blood vessels in all three diagnoses.
- Name of a Facility
- Date: 9/11/17
- Patient Name: ________ Birthday: _________
- Name of Medication: Nebivolol 10 mg (Khan et al., 2013).
- SIG: orally once per day
- # dispensed: 30 Refill None.
- Signature: __________
Mechanism of Action for Medications
Nebivolol helps to treat high blood pressure as one of the most effective and less harmful beta-blockers. It relaxes blood vessels, slows down the heart rate, and decreases blood pressure. It helps to control special receptors with the help of which the heart rate is increased, and the heart starts consuming more oxygen. Nebivolol aims at lowering the heart rate and improving the condition of blood vessels.
Watch Outs for Medications
The main adverse effect of taking Nebivolol is the possibility of observed decreased blood pressure and improve the condition of blood vessels regarding the current changes. However, it is also necessary to consider such side effects as a headache, dizziness, diarrhea, rash, and chest pain. In some cases, sleeping problems can be observed in patients. As soon as some of these effects occur, the patient should address the doctor and discuss the possibility of another medication.
The patient should understand the importance of a treatment plan including the pathophysiology of the disease, home monitoring, and taking all drugs precisely (Woo & Wynne, 2011). Lifestyle changes, safe diets, and communication with doctors are integral in patient education as well because they help to prevent further complications with the heart work. In this case, all three diagnoses are connected with the work of the heart. It is necessary to educate the patient about the peculiarities of the heart work and the dependence of the heart on other systems of the body.
Monitoring of Medication Effectiveness
It is recommended to visit a doctor in one week and take the blood test to check if Nebivolol helps the patient. In case some side effects are observed, it is necessary to address a doctor as soon as possible and choose another medication to control the work of blood vessels.
Almost the same treatment decisions and discussions are developed by Banegas et al. (2014), Khan et al. (2013), and Tanai and Frantz (2015). Their research helps to understand common issues of such diseases as heart failure, hypertension, and myocardial infarction. They investigate the work of the heart and a variety of complications people may be exposed to.
Banegas, J.R., Ruilope, L.M., de la Sierra, A., de la Cruz, J.J., Gorostidi, M., Segura, J., … Williams, B. (2014). High prevalence of masked uncontrolled hypertension in people with treated hypertension. European Heart Journal, 35(46), 3304-3312.
Bonaca, M.P., Bhatt, D.L., Cohen, M., Steg, P.G., Storey, R.F., Jensen, E.C., … Bengtsson, O. (2015). Long-term use of ticagrelor in patients with prior myocardial infarction. New England Journal of Medicine, 372(19), 1791-1800.
Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Blaha, M.J. … Franco, S. (2014). Heart disease and stroke statistics – 2014 update: A report from the American Heart Association. Circulation, 129(3), 28-292.
Khan, M.U., Zhao, W., Zhao, T., Al Dazari, F., Ahokas, R.A., Sun, Y., … Weber, K.T. (2013). Nebivolol: A multifaceted antioxidant and cardioprotectant in hypertensive heart disease. Journal of Cardiovascular Pharmacology, 62(5), 445-451.
Tanai, E., & Frantz, S. (2015). Pathophysiology of heart failure. Comprehensive Physiology, 6(1), 187-214.
Woo, T.M., & Wynne, A.L. (2011). Pharmacotherapeutics for nurse practitioner prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company.