The Patient Complained of Congestive Heart Failure Discussion
***REPLY TO DISCUSSION BOARD AND 2 REFERENCES REQUIRED***
Case Study: Anemia
A 50-year-old woman presents with complaints of excessive fatigue and new activity induced shortness of breath. Past medical history includes congestive heart failure and kidney disease. Vital signs show an increased heart rate of ninety-two and increased respirations at twenty-eight. The patient’s lab results show a decreased hemoglobin at 9.5 g/dL, and per the patient’s history her hemoglobin normally ranges from 11 to 13 g/dL. The patient’s hematocrit is also decreased at 29%. On assessment the patient appears fatigued and has a pallor complexion.
The first steps in the patient’s plan of care would be to communicate with the patient and gather some more subjective data, including when these new symptoms began, if anything makes the symptoms better or worse, and if she has attempted any treatment. I would also discuss if the patient follows with a cardiologist or nephrologist for medical management. As her provider I would then want to complete a full head to toe assessment, with a focus on her cardiac and pulmonary assessment. Due to her history of congestive heart failure I believe it would be important to assess her for edema, adventitious breath sounds and arrhythmias. Some additional signs and symptoms to monitor for may include headache, dizziness, and weakness. Differential diagnosis for this patient would include anemia and iron deficiency anemia.
Developing a treatment plan for patients who suffer from concomitant heart failure and anemia can be tough. Blood transfusions have been shown to only be a temporary fix for these patients, and do not target the root cause of the issue. The first line of treatment should include identifying any hematinic deficiencies, such as iron, B12 or folate. These findings may aid in the developing specific treatment goals. Additional treatment options for the anemia may include iron supplements, both intravenous and oral, or erythropoiesis-stimulating agents. My specific treatment plan for this case study would involve ordering the patient iron supplementation, monitoring her hemoglobin and hematocrit levels, and having her follow up with her nephrologist and possibly a hematologist for further management.
This case study allowed me to do further research into the pathology and treatment options of anemia in patients who suffer from heart failure and chronic kidney disease. Anemia in heart failure patients is a more common issue than I was aware of. According to Gonzalez-Costello et al. (2018), approximately fifty percent of heart failure patients suffer from iron deficiency. I was also unaware that in heart failure patients a lower hemoglobin may actually preserve a patient’s left ventricular ejection fraction (LVEF), as hemoglobin is inversely related to LVEF (Anand & Gupta, 2018).
In my opinion the largest challenge of this case study would be developing a useful treatment plan. Unfortunately, as discussed by Sirbu et al. (2018), anemia in heart failure patients causes a significant higher mortality rate. Multiple mechanisms appear to contribute to poor outcomes in these patients including reduced oxygen delivery to metabolizing tissues and renal alterations leading to increased myocardial workload and possible LV hypertrophy (Anand & Gupta, 2018).
I believe this week’s case study will benefit me as an advanced practitioner because it has increased my knowledge regarding not only iron deficiency and anemia, but also aspects of congestive heart failure. I believe working in the primary care setting I will be closely monitoring patients who live with congestive heart failure, iron deficiency anemia, and chronic kidney disease. I am hopeful that I can use the knowledge I have gained from this study and put it towards my practice.
Anand, I. & Gupta, P. (2018). Anemia and iron deficiency in heart failure: Current concepts and emerging therapies. Circulation, 138(1), 80-98. https://doi.org/10.1161/CIRCULATIONAHA.118.030099 (Links to an external site.)
González-Costello, J., Comín-Colet, J., Lupón, J., Enjuanes, C., Antonio, M., Fuentes, L., Moliner-Borja, P., Farre, N., Zamora, E., Manito, N., Pujol, R. & Bayes-Genis, A. (2018). Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: Insights from an observational cohort study. BMC Cardiovascular Disorders 18(206), 1-11. https://doi.org/10.1186/s12872-018-0942-x
Sîrbu, O., Floria, M., Dascalita, P., Stoica, A., Adascalitei, P., Sorodoc, V., & Sorodoc, L. (2018). Anemia in heart failure: From guidelines to controversies and challenges. Anatolian Journal of Cardiology, 20(1), 52–59. https://doi.org/10.14744/AnatolJCardiol.2018.08634