Heart Failure
Heart Failure
Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.
Medical History:
His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years.
Medications:
His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver.
Diagnosis: Heart Failure Class II
List specific goals of treatment for Michael.
What drug(s) would you prescribe? Please provide rationales.
What are the parameters for monitoring the success of your selected therapy?
Discuss specific patient education based on the prescribed therapy.
Describe one or two drug–drug or drug–food interactions for the selected agent(s).
List one or two adverse reactions for the selected agent(s) that would cause you to change therapy.
What would be the choice for the second-line therapy?
What over-the-counter or alternative medications would be appropriate for Michael?
What dietary and lifestyle changes should be recommended for Michael?
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