¶ … M.K., a 45-year-old female who has a history of Type II diabetes mellitus and primary hypertension. In addition to this, M.K. is overweight and persists with a poor diet. The patient has also been smoking for the past 22 years, and has recently been diagnosed with chronic bronchitis. Current symptoms include chronic cough, which tends to be more severe in the mornings and productive with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. The patient is currently on several medications including Lotensin and Lasix for the hypertension, along with Glucophage for the Type II diabetes mellitus. From an analysis of M.K.'s lab results, this report will offer clinical findings and treatment recommendations, as well as suggestions for what other conditions M.K. may be at risk for given her health history, lifestyle, and lab results as follows: Vitals

BP

158/98 mm Hg

CBC

Hematocrit

57%

Glycosylated hemoglobin (HbA1c)

Arterial Blood Gas Assessment

PaCO2

52 mm Hg

PaO2

48 mm Hg

Lipid Panel

Cholesterol

242 mg/dL

HDL

32 mg/dL

LDL

173 mg/dL

Triglycerides

1000 mg/dL

Hypertension: Is M.K. experiencing heart failure?

One in every three American adults has high blood pressure, and about half of them have the condition under control (CDC, 2016). According to the CDC (2016), 35% of women in M.K.'s age bracket have high blood pressure. High blood pressure can and does increase the patient's risk for having a heart attack (70% of people having a heart attack have high blood pressure), a stroke (80% of people who have a stroke have high blood pressure), chronic heart failure (70% of people with chronic heart failure had high blood pressure), and kidney disease (CDC, 2016). M.K.'s high blood pressure qualifies as being "controlled" because she is taking medications. The patient's vital signs most recently revealed her blood pressure to be 158/98 mm Hg, which is actually still high and qualifies M.K. for being diagnosed with Stage 1 Hypertension. The patient is currently taking several drugs for managing her medication for hypertension. Lasix is a diuretic that happens to be frequently prescribed in conjunction with Lotensin because the two drugs can have a positive and synergistic effect on treating the hypertension and helping M.K. keep the high blood pressure under control. Unfortunately, M.K.'s hypertension remains uncontrolled in spite of these interventions.
Moreover, M.K.'s uncontrolled pulmonary hypertension places the patient at increased risk of developing the aforementioned health problems including heart failure, which given the cluster of problems she currently faces, may have already happened (Wolf-Maier, et al., 2004). There are, however, several types of heart failure: left-sided, right-sided, and congestive. Left-sided heart failure can be systolic or diastolic. Diastolic left-sided heart failure is also known as diastolic dysfunction. Diastolic dysfunction refers to the inability of the left ventricle muscles to relax and refill with blood; the muscle has stiffened. With systolic left-sided heart failure, the ventricle cannot contract or pump with enough force to circulate the blood. Both of these types of left-sided heart failure can be treated with drugs, but different drugs would be indicated for each condition.

Of course, it would be better to prevent any heart failure that has not already occurred in the patient. In fact, right-sided heart failure, also known as right ventricular heart failure, usually follows left-sided heart failure (American Heart Association, 2015). Congestive heart failure can be even more severe, causing edema and interfering with the kidneys in other ways, too (American Heart Association, 2015). M.K.'s protruding neck veins and her persistent coughing may indicate that she has already suffered from at least one type of heart failure and should get evaluated further. In M.K.'s case, an echocardiogram would clarify which type of heart failure she may have. Right-sided heart failure is more closely connected with M.K.'s comorbidity, including both uncontrolled hypertension and the bronchitis, which is classified under the rubric of chronic obstructive pulmonary disease (COPD). Therefore, it is suspected that M.K. may have right-sided heart failure; an echocardiogram will clarify further. Medications like Lasix can help patients like M.K., but she may also need to add additional pharmacological treatments like beta blockers, angiotensin II receptor blockers, Aldosterone antagonists, or inotropes if the condition worsens. Given the patient has already been prescribed Lanoxin, it is also likely that the medical team has recognized symptoms of systolic heart failure already.

As M.K. is hypertensive, and because her medications are failing to fully control the hypertension due to her smoking and poor diet, it is easy to see how she is at an especially high risk for heart failure. M.K. is one of the two-thirds of Americans who are at increased risk for cardiovascular events like heart failure because of inadequate blood pressure control: "only 34% of the 50 million American adults with hypertension have their blood pressure controlled to a level of