Question 6

The patient needs to take the recommendations in question 5 or he likely has a very dim future if his BP and cholesterol is not lowered a lot. Blood pressure should be measured after the patient has rested for at least five minutes. He should be instructed in advance of the appointment what not to eat or drink so that the test result is not improperly influenced (e.g. drinking caffeine).

Question 7

There is no advancement or progression in symptoms but blood pressure is still entirely too high. It needs to drop by at least 30 points to be within a non-hypertension range. Needs to be made clear to patient that while he is feeling fine for now, that will change if the proper lifestyle changes are not made.

Question 8

A full batter of blood work should be done to get the full picture of what is really going in with the patient. A urinalysis should also be done because that could be instructive as well.

Question 9

The cholesterol is indeed out of whack. The good amount is too low and the bad amount is too high. The QRS voltage is an indicator of LVH and is likely a precursor or symptom of heart issues based on family history and the totality of the symptoms.

Question 10

The lifestyle changes named earlier are now urgent and the patient should be monitored for blockages in arteries as well as heart scans/analysis to find out what, if anything, is systemically or physically wrong with the function and structure of the heart.

2. Chapter 4: Heart Failure

Question 1

There are multiple symptoms in play here that are indicative of congestive heart failure. Specifically, the swelling in the hands and feet, the consistent shortness of breath, the patient's age and the fatigue he is having.

Question 2

The edema in the feet and...

The pulse is a bit weak and the patient's strength is not optimal although that is not entirely surprising given the age of the patient. The cool and pale skin is also not a good sign.
Question 3

A full battery of tests should be done including full blood work, a urinalysis test, a chest radiograph and an electrocardiogram. All of these are relevant, each for their own reasons.

Question 4

As a proactive set of measures, it would probably be a good idea to prescribe beta blockers and a diuretic. The patient should keep aspirin on hand in case of a possible heart attack.

Question 5

There is a set of facts that come from these results that confirm that congestive heart failure is in play. The cardiomegaly is one of them. The pleural effusions are another. The perihilar infiltrates are another. These items could each be caused by issues not related to congestive heart failure but these facts along with the other symptoms make that extremely unlikely.

Question 6

Extra tests to rule out other disorders causing the symptoms found previously should be done just to ensure that the patient is not actually suffering from something other than congestive heart failure or something else in addition to CHF, but the primary course of treatment has been and should remain congestive heart failure therapies.

Question 7

Inotropes are probably not necessary given that the diuretic is seemingly doing its job. However, continued use of the diuretic, beta blockers and ACE inhibitors would be called for.

Question 8

The patient needs to stop smoking immediately. The patient needs to keep her weight under control if it is not already. The patient needs to eat a good diet that helps keep sodium, cholesterol and fat under control.