Interstitial Pulmonary Edema Breaking Point Case Study

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Strong wheezing, indicative of cardiac asthma, is also probable. Noisy breathing efforts make cardiac auscultation hard. Signs like neck vein distention and peripheral edema may occur and indicate right ventricular failure (Arnold).

Diagnosis

Interstitial pulmonary edema is diagnosed when clinical evaluation reveals severe dyspnea and pulmonary crackles (Arnold, 2009). Diagnosis is also made by chest x-ray, serum natriuretic peptide or N-terminal-pro BNP, ECG, cardiac markers and other tests for etiology. In most cases, chest x-ray is immediately performed and establishes the diagnosis with marked interstitial edema. If the diagnosis is inconclusive, bedside measurement of serum BNP levels will help. ECG, pulse oximetry and blood tests are conducted on severely ill patients. An ECG will help identify the cause of the pulmonary edema and direct the choice of treatment. Possible causes of pulmonary edema may be myocardial infarct, valvular dysfunction, hypertensive heart disease, are dilated cardiomyopathy. Severe hypoxemia may also occur. Retention of CO2 is a late and unfortunate indicator of secondary hypoventilation (Arnold).

Treatment

This consists in treating the condition, which causes heart failure, lifestyle change, medications, surgery and other interventions (Arnold, 2009). Regimen typically includes oxygen, IV nitrates, diuretics, and morphine. Short-term IV positive inotropes, endotracheal intubation and mechanical ventilation may also be used. Initial treatment oftentimes consists of 100% oxygen by non-rebreather mask in upright position; furosemind; sublingual nitroglycerin; and IV drip. Additional treatment will depend on etiology, thrombolysis or coronary angioplasty for acute MI or another acute coronary syndrome; an IV vasodilator fir severe hypertension; direct-current cardioversion for tachychardia; and an IB B-blocker, IV digoxin. Other treatments may explore the use of IV BNP and the new intropic drug, levosimendan (Arnold).

Prognosis

Many people who experience heart failure continue to live for many years (Arnold, 2009). However, 70% of them die of the condition within 10 years.

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The severity of the heart failure determines life expectancy if the cause can be corrected and according to the treatment used. About half of all of those with mild heart failure live at least 10 years longer, with severe heart failure live for at least 2 years more. Treatment improves life expectancy. But the quality of life of a person with chronic heart failure is likely to deteriorate. The possibilities for further treatment are also likely to be limited, especially for older patients who cannot opt for heart transplantation. The decision should involve the patient and all his family members. Heart failure can, however, lead to sudden and unexpected death without a worsening of symptoms. Persons suffering from heart failure should provide for the type of care they prefer in cases when they are unable to make such decisions (Arnold).

Case Study

A 65-year-old male was admitted for acute-on-chronic left ventricular systolic failure. He has a medical history of ischemic cardiomyopathy and diabetes mellitus and underwent status pos coronary angiography the past month. He was diagnosed with interstitial pulmonary edema after an x-ray examination. He requires oxygen supplementation. His daily medications are spironolactone 25 mg, aminodarone HCL 200 mg, carvedilol 3.125 mg twice, furosemind 40 mg, enoxaparin sodium 40 mg, clopidogrel bisulfate 75 mg, and lisiopril 10 mg. He also takes simvastatin 20 mg at bedtime.

Conclusion

Chest x-ray examination reveals the presence of interstitial pulmonary edema in the patient. His medical history of ischemic cardiomyopathy and diabetes mellitus confirms research findings that these conditions are among the causes of interstitial pulmonary edema (Arnold, 2009 & 2008). #

BIBLIOGRAPHY

Arnold, M.O. (2009). Pulmonary edema. The Merck Manual Medical Library: Merck & Co., Inc. Retrieved on February 6, 2011 from.....

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