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Abstract: The patient, an 80-year-old woman, came to our hospital for further diagnosis and treatment because she felt chest tightness and shortness of breath during activity and after lying down at night with swelling of the lower extremities 1 week ago. I took the patient’s medical history, combined with her clinical manifestations and routine electrocardiogram, and confirmed that the patient’s symptoms were caused by chronic heart failure, and she was hospitalized with the patient’s consent for diuretic, anticoagulant, vasodilator and cardiotonic treatment. At the time of discharge, the patient’s condition improved, with relief of chest tightness and shortness of breath and disappearance of lower limb swelling.
Basic information】Female, 80 years old
Disease Type】Chronic heart failure
Hospital】Senior Hospital of Central South University
Date of consultation】June 2021
Treatment plan】Intravenous injection (nitroglycerin injection, furosemide injection, digoxin injection), oral medication (rivaroxaban tablets, spironolactone tablets, sakubatril valsartan sodium tablets, atorvastatin calcium tablets)
[Treatment period] Hospitalized for 8 days
Treatment effect] The condition improved, chest tightness and shortness of breath were relieved, and swelling of lower limbs disappeared.
I. Initial interview
The patient, 80 years old, female, started to have recurrent chest tightness, shortness of breath and a feeling of suffocating in the precordial region 5 years ago, which lasted for about half an hour and then relieved. One week ago, the patient’s symptoms worsened, and she felt shortness of breath during activity and at night after lying down, which was relieved after resting or sitting, accompanied by swelling of the lower limbs, and her condition did not improve significantly. On examination, he was found to have an enlarged heart border to the left, a heart rate of 120 beats/min, absolute arrhythmia, and low heart sounds, and a routine electrocardiogram indicating atrial fibrillation with rapid ventricular rate, mild ST-segment downward shift and T-wave changes in some leads, and a high degree of cis-clockwise transposition. He was diagnosed with chronic heart failure and admitted to the hospital. He had a history of coronary heart disease and ischemic cardiomyopathy for many years.
II. Treatment history
After the patient was admitted to the hospital and the relevant tests were completed, I told the patient that since there was no indication for surgery, pharmacological treatment was recommended to relieve his symptoms. After obtaining the consent of the patient and his family, I gave the patient nitroglycerin injection, furosemide injection, digoxin injection, as well as rivaroxaban tablets, spironolactone tablets, sakubatril valsartan sodium tablets, and atorvastatin calcium tablets for diuretic, anticoagulant, vasodilator, and cardiotonic treatment. After 8 days of hospitalization, the patient improved significantly and was discharged to recuperate, but was instructed to review the patient in 1 month to clarify changes in his condition. After the condition was determined to be stable, the patient could be re-examined once in 3-6 months.
III. Treatment effect
Before the above treatment, the patient felt shortness of breath during activity and at night after lying down, with swelling of the lower limbs. After 8 days of hospitalization, the patient’s general condition was good, with relief of shortness of breath and no edema in both lower limbs; there were no symptoms of dyspnea, palpitation, fever, etc. The physical examination revealed that the patient was clear, the breath sounds of both lungs were clear, no dry and wet rales were heard, there was no elevation in the precordial area, the heart rhythm was uniform, and no pathological murmurs were heard in the heart auscultation areas.
IV. Precautions
I am very happy for the patient that his condition has improved and he can be discharged home to recuperate. However, in order to keep the patient’s condition stable and not to have recurrent attacks after going home, I need to make the following suggestions for the patient.
1, because the heart function of patients with chronic heart failure is relatively low, they cannot accept the stimulation caused by strenuous activities or overexertion, so patients need to pay attention to more rest to protect the heart and avoid stimulation to the heart. However, patients can properly perform aerobic exercises, such as tai chi, which are beneficial in helping the heart to recover.
2. Patients also need to pay attention to a low-salt diet, drink an appropriate amount of water, and try to keep their weight from increasing, otherwise it may lead to water and sodium retention, which will increase the burden on the heart and is not conducive to the stability of the disease.
V. Personal insight
Chronic heart failure usually leads to chest tightness, shortness of breath, and swelling of the lower extremities, which cannot be cured. As in this case, after diagnosing her condition, I gave her the above-mentioned anti-cardiac failure medications and instructed her to pay attention to lifestyle improvements after discharge in order to keep her condition as stable as possible and prolong her long-term survival rate. It is also recommended that people with chronic heart failure should have their heart function reviewed regularly at the hospital to detect any further deterioration of chronic heart failure in time for targeted treatment.