Cardiovascular dysfunction (heart failure)
A 64-year-old woman presents to the primary care office with shortness of breath, leg swelling, and fatigue.
She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for
daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of
breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has
to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has
a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration in bilateral bases. The cardiac exam
reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted
in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An
echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection
fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI.
1- Discuss the pathophysiological mechanisms that can lead to heart failure.
2- Differentiate between systolic and diastolic heart dysfunction
3- Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night and the need to
prop herself up on three pillows. Include pathophysiological mechanisms that causes each of these signs and
symptoms.
