NR 507 PATHOPHYSIOLOGY WEEK 3 TD2 Vascular, Cellular and Hematologic Disorders Discussion Part Two (NR507)

Exam (elaborations) NR 507 PATHOPHYSIOLOGY WEEK 3 TD2 Vascular, Cellular and Hematologic Disorders Discussion Part Two (NR507) Week 3: Cardiovascular, Cellular, and Hematologic Disorders - Discussion Part Two Loading... This week's graded topics relate to the following Course Outcomes (COs). 1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1) 2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1) 3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7) 4 Distinguish risk factors associated with selected disease states. (PO 1) 5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1) 6 Distinguish risk factors associated with selected disease states. (PO 1) 7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4) Discussion Discussion Part Two (graded) 0 Responses Lorna Durfee 5/16/2016 9:26:22 PM Discussion Part 2 Discussion Part Two (graded) aJnedss oec icsa as i5o7n-ayle eapri-goaldst mrica lpea winh.o Hpree ssteanttess wthitaht gart andiguhatl hoen sheats o tfr doyusbplen ebar eoant heixnegr teiospne acniadl lfya twighuilee. lHyien agl soon choism bpalacikn. sT ohfi sfr iesq rueelnietv deyds pbeyp hsiima wsiittthin nga uups.e a His vitals are 180/110, P = 88, T = 98.0 C, R = 20. nSauubsjeeac tainvde :o c5c7a-syieoanra-lo eldp imgaaslter iwc hpoa s with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia with The patient states that he has trouble breathing at night especially while lying on his back. This condition is relieved when he sits up. Objective: His vitals are 180/110, P = 88, T = 98.0 C, R = 20. Write a differential in this case and explain how each item in your differential fits and how it might not fit. Doctor Brown and Class: TWhhise np astlieeenpti,n agc,c tohred ipnagti teon tG hoausl din acnreda Dseyde br l(o2o0d1 1v)o lius mexeh iinb itthine gl usniggns sl eoafd pinargo txoy fslmuiadl inno tchtue ranlavle doylis.p nTehae afnludi dth we ipllr einsetenrcfee roef wacituht ed ipfufulmsioonna orfy oexdyegmean. a nd therefore lung expansion (Gould & Dyer, 2011, p. 300). This condition leads to pulmonary edema and can be caused by left-sided heart failure. 0 0 DIFFERENTIAL: CONGESTIVE HEART FAILURE: Gould and Dyer (2011) state that congestive heart failure (CHF) occurs when the heart can no longer pump the necessary blood demands of the body metabolically. Congestive heart failure can happen as a result of infarction or valve defect. It can arise fro mto imncereeta asleld t hdee mands hplyapceerdte onns itohne ahfefaerctt,s s tuhceh l eafst hvyepnetrritcelnes ifoirns to. r Pduislmeaosnea orfy tvhael vluen sgt.e n Oosnies sciadne aofff ethcte thheea rritg fhati lvse fnirtsritc tlhee. n I tt hies iomthpeorr. t aInntf atorc dtieocni pohfe trh we hleifcth v seindter iictl ies .o rI t is left- sciodneddi toior nrisg lheta-dsi tdoe dth Ce HseFc r(eGtioounl do f& in Dcryeears, e2d0 r1e1n,i pn. a2n9d7 a).l d Toshteerreo nise .a rTehdeu creesdu fllto iws v oafs obclooonds tirnictoti othne a snyds taenm iincc creiracsuelda taifotne,r laonadd tahnedn itnhcer ekaidsende ybsl.o oTdh ese pveorliupmheer oarl rperseilsotaadn cwe.h Tichhe ared diss am doercer ewaosrek i nfo trh teh eef hfiecaiertn (cGy ooufl dth &e h Deayretr. , T20h1e1 h, epa.r t2 9ch8a).n gTeh dei lsaytmesp, aatnhde ttihce n cearvrdoiuasc smysutsecmle tthheenn ihnycpreearstreosp hheieasrt. r Tathee a wnda ll roefp tlhaec ehde awrti tvhe fnitbrrioclues btiescsoume e(Gs tohuilcdk .& T Dhyise rc,o 2n0d1it1io, np .l e2a9d9s) .t o increased demand for blood supply to the myometrium. The myocardial cells die and are This item may fit: Dweylslp anse tah eo nd ieaxpehrrtaigomn a -ndW vaaghalsl (r2ec0e1p2t)o rresl, arteegsu tlhaatet cbhreemathoirnegce. p Ttohres cino rtthicea bl raanind acnerde vbaraslc uplaatrh wsyasytesm al,l oasw w aeplpl raasi smale ochf athneo rsetcaetupst oorfs tihne t lhuen cghse. s Wt whaelnl aas ipsacthieenmt ihaa asn ddy csopnngeae sitti vcae nf abielu rrees apsir wateolrly a, sn CeuOroPgDe,n liucn ogr dciasredaisaec ainn do rpingeinu m(Wonaihal sa,n 2d0 d1i2s,o prd. e1r7s3 t)h. a tS ahroer tpnseyscsh oofg berneiact.h Hcaen s tbaete rse ltahtaetd c taor dmiayco acnadrd ial opfu lbmreoantahr oyn e teixoelortgioyn d (oWmainhalste, s2 i0n1 2m, ops.t 1o7f4 t)h.e cases (Wahls, 2012, p.173). The description of the exacerbation of heart failure is a sensation of shortness This item may not fit: dByescpanuesae itsh ea cpuatteie wnth ceonu iltd d hevaveleo apnso otvheerr hcoonudrsi ttioo nd athyast amnday c hbreo cnaicu siifn mg othree tdhyasnp nfoeuar o tno beoigthh te wxeeretkiosn. a Tnhde a ct anuigseh to. f dSycshpwnaerat zcsotueilnd (b2e0 a1 5n)e wco pnrfoirbmlesm th oart a worsening underlying disease (e.g., asthma, COPD, or heart failure) (Schwartzstein, 2016). This may fit: pFuamtigpu eeno–u gThh eb lAomode rtoic amne Hete tahret Adesmsoacnidatsi oonf t(h2e0 1b5o)d yre. l aTtehse tbiroeddyn ethsse na nsden fdasti gthuee balroeo pda frrto omf tlhees ss ivgintasl aonrdg asnysm, tphteo mmsu oscf lhees airnt tfhaeil ulirme.b sT, haen dh esaerntd csa intn toot the heart and brain. The result is fatigue (The American Heart Association, 2015). This item may not fit: Because fatigue can happen for various reasons. Further evaluation is warranted. This item may fit: sDyymsppteopmsisa oafn pdr eespsiugraes, tbruicrn pinagin a–ndT thiigsh ctnoensdsi tiino nth ceo cuhldes bt ea rcea usisgends b oyf aannggiinnaa.. ITt hstea Nrtsa tbioehnianl dH tehaer tb, rLeausntgb,o anned. BAllosood, tIhnesrtei tcuaten (b2e0 a1 1p)a rinem inin tdh eu as rtmhast, neck, jraewla,t etdh rtooatC oorr obnaacrky. H Seoamrt eDtiimseeass eit. isP haatriedn ttos dtheastc rIi hbaev we hcearree dth feo pr asionm ise tcimomesi nhga vfreo hma d(T ehxec eNssa tfilouniadl iHn ethaert ,b Loduyn,ga anndd i tB cloano dc aInusstei tcuoten,g 2e0st1io1n)., aAnndg tihnias icsa n be from congestive heart failure. This item may not fit: We do not know what other medical issues are present. There needs to be an evaluation of this patient with testing and further physical examination. This may fit: Nwiotcht udirfnfuasl iDony sopf noexayg-eWn haennd stlheeerpeifnogre t hluen pga teixepnat nhsaiso nin (cGreoausledd &bl oDoyde rv,o 2l0u1m1e, ipn. 3th0e0 l)u. n gTsh, iasn cdo nthdiist iloena dcso utold f llueiadd i tno t nhoe catluvrenoalli ,d aynsdp ntheaa ta wndil lc ionutledr fbeere a sign that the heart is not functioning properly. This item may not fit: However, there could be another problem such as COPD or pulmonary function issues. Testing is needed. This may fit: fBrolomo dth Per leesfst utor et:h e1 l8e0ft/ 1a1tr0iu-m T ahned styhsetno ltioc tahned l edfita vsteonltirci cplree.s sWurieths alereft -bsoidthe de lheevaartte dfa. i lWuriet,h t hleefrte- scidaned b he eaanr ti nfaaibluilriety, tohfe t hheea lretf mt voevnetsri oclxey tgoe nco-rnictrha cbtl ood fniollr mwaitlhly b. lIot ocda npnroopt eprulysh w eintho urgesht ionfg t hine bbelotwodee inn tboe caitrsc (uTlahteio Anm. Terhicea lne fHt veaerntt rAicslseo lcoiasetiso int,s 2a0b1il5it)y. to relax because the muscle is stiff. The heart cannot This item may not fit: The high blood pressure can be from hypertension and needs to be ruled out. We need to identify what type of hypertension exists. AWshsuatm tee sytos uwro fuirldst ydoiuff eorrednetri?a lW is hdaetf iinmitmiveed. iate treatment would you consider giving this patient and what treatment when he went home? hTeeasrtts aton do rvdeenrt raincdle Ttore faitlml wenitth: oCro eljueccct ib (l2o0o1d5. ) T shteartees a trhea st pheecairfti cf asiylumrpe tiosm cso:m spulcehx assy dnydsrponmeea calnindi cfaatlilgyu. e I,t acnadn sriegsnusl tr ienla atinnyg d tios oflrudiedr rtehtaetn itmiopna. i rTs hthe ew ays to assess cardiac function is numerous. There needs to be a careful history and physical (Colucci, 2016). fAartingouled. ( 2W01it3h) riingfhotr fmaisl uurse t, hiat tc haueaserts fpaeilruipreh eisra al saynndd arbodmoem oifn avle fnlturiidcu alcacr udmysufluanticotnio. n T. h We vitehn lterfict lveesn atrreic iunlvaor lfvaeildu reeit, htehre rteo gise tshheorr otnr essesp oafr abtreelyat. h Tanhde basis nofa ttrhiue rientiitci aple dpitaidgenso.s iHs eis soung gcelisntisc aasl fai ntrdeiantgms.e n Tt htoe sstuaprpt owritt ho fp tahtiise ndti aegdnuocsaitsi ocna,n d biuer betyi cc hmeesdt ixc-artaiyo,n e, cAhCocEa irndhioibgirtaoprhs,y a anngdio otebntasiinni nIIg r leecveepltso or fb plolacskmeras , beta-blockers, and other medications. Also the use of digitalis and pacemakers and to definitively find the underlying disorder (Arnold, 2013). oNboswer, vhaet icoonm?e sI fb tahcisk ptaot iyeonut rh acsli cnoicn g3e mstiovnet hhesa lratt feari launred, bswotehll ihnigs ainn bkoleths aarnek lselsig ihs talyn ostwheorl lseing.n W. Thhaist cpoonsdsiibtiloen e mxpelaannsa tthiaotn tsh ae rpea ttiheenrte i sf orre ttahinisin g fnleueidds. aSnt eervnasl u(2a0ti1o6n) f orer lcahterso nthica tv eedneomusa dinis ethaes ea,n dkeleeps ivse cina ltlhedro pmebriopshise,r ahle eadrte mfaial.u rHe ea ncdo ual dre nvoieww h oafv eh ipsu mlmedoincaartyio endse(mStae arnnsd, w20o1r6se).n ing heart failure. He References Arnold, M. O. (2013). Heart failure. In Merck Manual online. Retrieved from heart-failure#Treatment Colucci, W. S. (2016). In T. W. Post (Ed.), UpToDate. Evaluation of the patient with suspected heart failure. Retrieved from Gould, B. E., & Dyer, R. M. (2011). Cardiovascular disorders. In Pathophysiology for the health professions (4th ed., pp. 297 - 300). St. Louis, MO: Saunders/Elsevier. The National Heart, Lung and Blood Institute. (2011). What Are the Signs and Symptoms of Angina? Retrieved from Schwartzstein, R. M. (2016). In T. W. Post (Ed.), UpToDate. Approach to the patient with dyspnea. Retrieved from Sterns, R. H. (2016). In T. W. Post (Ed.), UpToDate. Edema (swelling). Retrieved from basics?source=see_link The American Heart Association. (2015). Types of Heart Failure. Retrieved from Failure_UCM__A#.Vzp5feTLnHI The American Heart Association. (2015). Warning Signs of Heart Failure. Retrieved from Failure_UCM__A#.Vzpw1-TLnHI Wahls, S. A. (2012). Causes and evaluation of chronic dyspnea. American Family Physician, 86(2), 173-182. 5/Jennifer Roth reply to Lorna Durfee 19/2016 11:27:21 AM RE: Discussion Part 2 Hi Lorna, What a great and thorough post. Obtaining the values of electrolytes is imperative in heart failure. Sodium and potassium are two vital values which affect heart arrhythmias as well as fluid congestion. Sodium tends to follow water so the value can give a provider a sense of how severe the heart failure is. Potassium is another key value due to the arrhythmias that can occur due to too low or too high of a value. Creatinine will demonstrate kidney function. Kidneys filter out excess fluid and if they are not working properly, then the excess fluid will present as edema in the lower extremities (AHA, 2015). An EKG will also be beneficial in that it will give information on the heart rhythm the patient is currently in and can be compared to a previous EKG if one is available. This will demonstrate the worsening of heart failure or if a new issue is arising. There are so many options to evaluate the appropriate course of diagnosing and treating heart failure. Each individual is different so there is not one way which is correct compared to another. Underlying medical conditions and non-compliance affect the outcomes for patients with heart failure. A you had previously mentioned, patient education is probably the most important intervention provided to patients with heart failure. There are changes patients can make in their daily lives to improve outcomes as well as complying with medical interventions. Jennifer Roth Reference Heart failure. (2015). Retreived from: Failure_UCM__SubHomeP Liberty Neoh 5/17/2016 8:16:10 PM Discussion Part Two Dr. Brown and Class, Write a differential in this case and explain how each item in your differential fits and how it might not fit. This patient is showing signs of Heart Failure (HF). Patients with heart failure are likely to present, exertional dyspnea, fatigue, orthopnea, exercise intolerance, and fluid retention which can lead to peripheral edema. Hypertension may be the single most important modifiable risk factor for HF in the United States. Hypertensive men and women have a substantially greater risk for developing HF than normotensive men and women Elevated levels of diastolic and especially systolic blood pressure are major risk factors for the development of HF (Yancy et al, 2013). What tests would you order? In ambulatory patients with dyspnea, measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical decision making regarding the diagnosis of HF, especially in the setting of clinical uncertainty. According to Yancy and colleagues (2013), “BNP or its amino-terminal cleavage equivalent (NT-proBNP) is derived from a common 108- amino acid precursor peptide (proBNP108) that is generated by cardiomyocytes in the context of numerous triggers, most notably myocardial stretch. Following several steps of processing, BNP and NT-proBNP are released from the cardiomyocyte, along with variable amounts of proBNP108, the latter of which is detected by all assays that measure either “BNP” or “NT-proBNP.” (Yancy et al, 2013). What immediate treatment would you consider giving this patient and what treatment when he went home? Diuretic-based antihypertensive therapy has repeatedly been shown to prevent HF in a wide range of patients; ACE inhibitors, ARBs, and beta blockers are also effective. Data are less clear for calcium antagonists and alpha blockers in reducing the risk for incident HF (Yancy et al, 2013). Now, he comes back to your clinic 3 months later and both his ankles are slightly swollen. What possible explanations are there for this observation? If patient’s symptoms are not improving and now the patient has swollen ankles, I need to investigate whether the patient complies with the pharmacologic management. If Jesse is following the treatments and taking his medications, it would mean that the current treatment plan is not working. Reference Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H.,…Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 62(16). doi: 10.1016/.2013.05.019 Rechel DelAntar reply to Liberty Neoh 5/18/2016 6:59:02 PM RE: Discussion Part Two Hello Liberty and class, It is important to assess not just for the effectiveness of the treatment but also patient compliance. This is sometimes often bypassed assuming patients will always follow the regimen. Studies show that in the United States alone, nonadherence to medications causes 125,000 deaths annually and accounts for 10% to 25% of hospital and nursing home admissions. This makes nonadherence to medications one of the largest and most expensive disease categories. Moreover, patient nonadherence is not limited to medications alone. It can also take many other forms; these include the failure to keep appointments, to follow recommended dietary or other lifestyle changes, and to follow other aspects of treatment or recommended preventive health practices.Therefore, actual implications of nonadherence goes far beyond the financial aspect of medication compliance (American College of Preventative Medicine, 2016). I agree with you that part of follow up should not just be the effects of the medication but is the patient following the regimen and if not why. References: American College of Preventative Medicine. (2016). Medication Adherence Time Tool: Improving Health Outcomes A Resource from the American College of Preventive Medicine. Retrieved from Lanre Abawonse reply to Liberty Neoh 5/21/2016 4:15:01 PM RE: Discussion Part Two Great Job on pointing out the impact of hypertension on heart failure. Hypertension is one of those diseases that are often ignored by many people over a long period of time because they are unaware they have it. Yarmolinsky, Gon, and Edwards (2015) stated that hypertension is the leading risk factor for disease globally. Hypertension can do significant damage to the heart by affecting the performance of the arteries. Normally, arteries expand and contract effortlessly with each heartbeat. With sustained hypertension, the arterial walls become thickened, inelastic, and resistant to blood flow. This process injures arterial linings and accelerates plaque formation, thus causing the left ventricle to pick up the slack of nonfunctioning blocked vessels. Reference Yarmolinsky, J., Gon, G., & Edwards, P. (2015). Effect of tea on blood pressure for secondary prevention of cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Nutrition Reviews, 73(4), p. doi:nutrit/nuv001 Rechel DelAntar 5/17/2016 9:44:24 PM Differential Diagnoses Hello Professor and Class, Differential Diagnoses This is a case of a 57-year-old gentleman complaining of gradual onset of dyspnea on exertion and fatigue. Also complains of occasional epigastric pain, dyspepsia and nausea. The patient expresses difficulty breathing at night when he is lying on his back. Noted elevated BP at 180/100, PR=88 R=20 and afebrile at 98C. Based on this presentation, the following diagnoses the patient is most likely having: 1. Heart Failure = often referred to as congestive heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. Heart failure is a physiological state in which cardiac output is insufficient to meet the needs of the body and lungs. The term "congestive heart failure" is often used, as one of the common symptoms is congestion, that is, build-up of too much fluid in tissues and veins (McCance, K.L., ., 2013). Specifically, congestion takes the form of water retention and swelling (edema), both as peripheral edema (causing swollen limbs and feet) and as pulmonary edema(causing breathing difficulty), as well as ascites (swollen abdomen) and dyspepsia. Another sign of heart failure is Paroxysmal nocturnal dyspnea manifested as shortness of breath while sleeping at night or in a reclining position, which is due to the lung’s air sacs filling up with fluid or pulmonary edema. Ischemic heart disease and hypertension are the most important predisposing risk factors (McDonagh, T., 2011). The patient symptoms fit the profile of heart failure. 2. Acute Coronary Syndrome = Coronary obstruction caused by thrombus formation over a ruptured or ulcerated atherosclerotic plaque. Unstable angina is the result of reversible myocardial ischemia and is a predictor of impending infarction while Myocardial infarction (MI) is the prolonged ischemia of the heart causing irreversible damage to the heart muscle (McCance, K.L., et. al, 2013). The classic symptom is chest pain due to ischemia of the heart muscles known as angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen, where it may mimic heartburn accompanied by dyspnea, weakness and fatigue (American heart Association, 2014). Although some of the symptoms fit the patient description, the patient is not experiencing chest pain, which is a classic sign of an MI or ischemia. 3. Pulmonary Hypertension = is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. Tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs' arteries. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and fail. Elevated pressures in the heart and lungs as well as the back flow of blood to the liver and kidneys produce symptoms of shortness of breath, tiredness, chest pain, elevated heart rate (Mayo clinic, 2016). Although some of the symptoms fit, the patient is not exhibiting chest pain and elevated heart rate present in PHN 4. GERD = Gastro-esophageal Reflex Disease is a chronic condition of mucosal damage caused by stomach acid coming up from the stomach into the esophagus (chronic reflux). Occasional reflux causes heartburn, but chronic reflux leads to reflux esophagitis, GERD, and sometimes Barrett's esophagus. GERD is usually caused by changes in the junction between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. Sign and symptoms are similar to cardiac symptoms of chest pain, dyspepsia, coughing as well as night time GERD Reflux. Night time reflux is associated with a more aggressive for of GERD (International Foundation for Functional Gastrointestinal Disorders, 2016) . Although the symptoms of this disease may be similar to what the patient is experiencing, it does not cause hypertension such as the one the patient is experiencing. 5. Pernicious Anemia = Anemia is a condition in which the body does not have enough healthy red blood cells. Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12. The principal disorder in PA is an absence of intrinsic factor (IF), a transporter required for absorption of dietary vitamin B , which is essential for nuclear maturation and DNA synthesis in erythrocytes. Symptoms develop slowly but the once the disease progresses; it will later include neurologic complication. Classic symptoms of anemia—weakness, fatigue, parenthesis of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, weight loss, and a sore tongue that is smooth and beefy red secondary to atrophic glossitis (McCance, K.L., 2013). This diagnosis does not fit the symptomatology of the patient because the patient is not experiencing glossitis and parenthesis. Also PA does not exhibit signs of shortness of breath at night while in bed. In the case of this patient suspected of having Heart Failure, some of the tests that could be ordered would be labs such as a complete blood count, complete metabolic panel, Cardiac function panel and BNP. Also it is important to get an EKG to identify heart rhythm or conduction abnormalities. An echocardiogram is also needed to assess heart function. A chest x-ray can be ordered in conjunction with the ECHO to assess cardiomegaly. Treatment is focused on improving symptoms and stopping disease progression. Assess their functional status to provide guidance to their treatment (NY Heart Class I-IV). Start with managing his uncontrolled BP, as hypertension is one of the predisposing factors for heart failure. Suggest using an ACE inhibitors, calcium channel blockers or ARB to control blood pressure and add a diuretics to remove fluids and decrease cardiac workload (McDonagh, T., 2011). Education counseling in cardiac diet such as limiting salt intake and to keep a blood pressure log. Patient comes back to clinic and noted bilateral pedal edema. Assess the degree of pedal edema and check for pulmonary congestion. Ask if symptoms have improved or not and check patient’s BP log to see BP trends. IF the patient expresses improvement, assess current meds that may be causing pedal edema. Check labs to assess effects of treatment and kidney function from diuretic use. May consider increasing diuretic therapy to unload fluid from the body. Also may consider coronary angiogram to assess patency of coronary arteries. If symptoms are worse, may consider hospital admission for advance heart failure therapies. References: American Heart Association. (2014). Heart Attack or sudden cardiac arrest: How are they different? Retrieved from Conditions/More/MyHeartandStrokeNews/Heart-Attack-or- Sudden-Cardiac-Arrest-How-Are-They Different_UCM__A#.VzvJXpMrJo4. International Foundation for Functional Gastrointestinal Disorder. (2016). GERD: Signs and Symptoms. Retrieved from Mayo Clinic. (2016). Pulmonary Hypertension. Retrieved from home/ovc-. McCance, K.L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby. McDonagh, T. (2011). Oxford Textbook of heart failure. Oxford: Oxford University Press. [4] 12 5/Lanre Abawonse 17/2016 11:14:55 PM Discussion Part Two Heart Failure (HF) occurs when the heart is unable to pump sufficient blood to meet the metabolic need of the body. The result of inadequate cardiac output is poor organ perfusion and vascular congestion in the pulmonary or systemic circulation. HF can be classified as systolic or diastolic, left sides(ventricle unable to produce a CO sufficient to prevent pulmonary congestion) or right sided(ventricle is unable to maintain an adequate cardiac output, and systemic congestion occurs), acute or chronic (Nicholson, 2014).HF may be described as backward or forward failure, high or low output failure. For backward failure, the ventricles fail to eject its content, which result in pulmonary edema on the left side of the heart and systemic congestion on the right. Forward failure causes inadequate CO which lead to decreased organ perfusion. Low output failure occurs when the ventricle is unable to generate enough CO to meet the metabolic demand of the body maintain an adequate cardiac output, and systemic congestion. In HF with preserved ejection fraction there is a compliance abnormality where relaxation of the ventricle is impaired (Shih & DeNofrio, 2016