Mrs. Smith experiences symptoms of heart failure which seems to have been caused by her hypertension, which is poorly controlled, given the blood pressure of 158/98. Her symptoms relate to a reduction of cardiac output as evidenced by fatigue and weakness, depleting her cardiac reserve, and excess fluid retention from elevated end-diastolic pressure (dyspnea, exertional dyspnea, bibasilar crackles, peripheral edema, decreased saturation). The decreased cardiac output is evidenced in a HR of 92, and is possibly related to her memory loss as well. Her symptoms seem to be manifestations of left-sided heart dysfunction, given her complaints of fatigue and weakness. (Porth, 2015). According to the ACCF / AHA Guideline for the Management of Heart Failure, patients with clinical manifestation of heart failure are at stage C of the algorithm (Yancy et al., 2013). Goals for therapy include …show more content…
First-line drugs for routine use include diuretics for fluid retention, ACEI or ARB, Beta blockers and aldosterone antagonists. Since there has been some noncompliance from Mrs. Smith in taking her beta-blocker, at this time I would not change this to a different type of medication but ensure better adherence to this drug first and evaluate the effect. Since she has already been established on this medication, the added diuretic might produce improvement in her symptom manifestation, if better medication compliance can be accomplished. If the outcome is insufficient, ACEI or ARB would be the next alternatives, with ACEI beneficial to improve her cognitive abilities as well. We do not have information about imaging studies, and therefore do not know her