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Congestive Heart Failure: Take Home Exam Anp 201

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Congestive Heart Failure: Take Home Exam ANP 201

Exam is due either by e-mail or turned into me by Wednesday April 27. Please remember all the academic honesty rules that pertain to this exam, you must write your own exam. Usually it appears that students have been sharing solutions because they have both given the same wrong answer! Document your sources, if other than our text and notes, by providing a reference page.

Good Luck!


A 64-year old patient has had Type II diabetes and high blood pressure. One thing he loves to do is keep a vegetable garden, but reports that lately, he has been feeling out of breath while doing these simple activities and you notice that his ankles are very swollen.

A number of tests are performed. The doctor does not suspect a current myocardial infarction for this patient. She marks the chart that the patient reports dyspnea and orthopnea. She calls for an ECG and an echocardiogram. She hears crackling noises called rales on auscultation of the lungs. X-ray images reveal an enlarged heart and a diagnosis is made of congestive heart failure. The patient is prescribed both a diuretic and digoxin, and surprisingly is referred to a physical therapist for an appropriate exercise routine.

1. Define the following terms: dyspnea, orthopnea, echocardiogram, rales, auscultation.

Answers: Dyspnea is a feeling of not being able to breathe or get air.

            Orthopnea is having shortness of breath when laying down.

            Echocardiogram is using a ultrasound waves to produce a visual display to diagnosis or monitor of heart disease.

            Rales is abnormal crackling sound heard when listening to a patient hearts who is not healthy.

          Auscultation is the process of listening to the heart or lungs of a patient with a stethoscope.

2. How do the patient’s existing diseases contribute to the development of congestive heart failure? Be very specific with information about cellular mechanisms that are affected by the existing diseases.

Answer: With the patient already having type II diabetes and hypertension puts a patient in higher risk of getting CHF. Congestive heart Failure is the pathological condition in which the left ventricle fails to pump blood adequately, causing backup of fluid in the lungs. With having diabetes the cells are unable to use glucose to turn into fats and proteins for energy. With having hypertension on top of that it puts high pressure on the arties causing damage to endothelial lining of the vessels and promotes plaque buildup. With having both of these pre-existing conditions it puts too much pressure on the heart causing the pumping of the blood to slow down.   

3. An ECG is performed to rule out a heart attack and to potentially help identify causes for the patient’s current problems. CHF can potentially develop from a previous heart attack or from a bundle branch block. Do a compare and contrast between a normal ECG, an ECG showing a myocardial infarction and one showing a bundle branch block.

Your answer can include the pictures with an explanation.

Answer: Normal ECG below

[pic 1]

ECG with MI  below

[pic 2]

ECG with Bundle Branch Block:

[pic 3]


Answer: With all three pictures above you can clearly see the differences between the three. First off on the PQRST waves are all three different. On a normal ECG there is equal P, QRS and T waves. Everything comes back to normal/baseline. There is no depression or elevation in a normal ECG. On a ECG with a MI, QRS waves are higher than normal and do not return to base line. Which is not depolarized and it cannot contract causing impairment in the pumping function of the heart.  On a ECG with a branch bundle block, the ST waves are not as visible, which is from the ventricles not fully contracting and repolarization. With a bundle branch block the patient needs to be seen immediately so the vessel can be opened up. Bundle branch block can sometimes hide ST elevation and sometimes ST depression. 

4. The doctor checks heart sounds for valvular deformity, since mitral valve stenosis has many of the symptoms reported by the patient. Research mitral valve stenosis, and explain why the symptoms would be similar. Would the heart sounds be different between CHF and mitral valve stenosis?

Answer: Heart sound of a CHF patient would sound more like lub dub lub dub lub lub dub. Because the heart is trying to pump faster making the ventricle larger in size than normal. Heart sound in mitral valve stenosis patient would be a lub dub dub, lub dub dub, lub dub dub. The heart would not be as fast but the ventricle is smaller in size so its trying to force more in which the dub dub is heard. 

5. The severity of heart failure is measured by the ejection fraction. This patient’s is 45%. Define ejection fraction and the meaning of the value obtained for this patient.

Answer: Ejection fraction is the percentage of blood that is pumped out of the heart with every heartbeat. With the percentage of 45% the patient is only pumping less than half of blood that is in the heart at each heartbeat. From my understanding there is a blockage in the heart or the valve from the CHF not allowing the right amount of blood to properly exit the heart on each heartbeat. 



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