Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.

Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.

The provided case study demonstrates a 62-year-old male patient diagnosed with heart failure class II. Even though the patient feels at ease when resting, with normal physical activity, he might trigger symptoms like shortness of breath, angina, palpitations, and tiredness. As such the main therapeutic objective of this patient at the moment is to lower his blood pressure. Additional treatment goals include having his breathing difficulties well-controlled and alleviating his sleeping problems. The improper gas exchange must also be remedied. The treatment plan for the patient will include angiotensin-converting enzyme inhibitors like losartan to lower his blood pressure, beta-blockers like Lopressor to reduce the risks of abnormal heart rhythm, and diuretics like hydrochlorothiazide and spironolactone to reduce the accumulation of fluids within his lungs (Rossignol et al, 2019). To determine the effectiveness of this treatment plan, it will be necessary to monitor the patient’s serum creatinine, respiratory rate, blood pressure, heart rate, and serum medication levels.

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The patient also needs to be educated on the importance of complying with the treatment regimen to promote positive outcomes. The patient must also be advised to regularly monitor his weight, as unintended changes in body weight may indicate fluid retention in the body. Physical exercise and consuming a heart-healthy diet are also crucial to promote the health of the patient and reduce his symptoms. Additionally, since the patient is using multiple medications, it is crucial to acknowledge the patient about drug-drug interactions like the use of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors concurrently can lead to increased risks of severe hyperkalemia (Pellicori et al, 2020). Nonsteroidal anti-inflammatory drugs (NSAIDs) also have the potential of decreasing the effect of antihypertensives like ACE inhibitors. Studies also show that the effect of ACE inhibitors is reduced with foods like red wine and tea.

The most likely adverse reaction that might affect the patient as a result of the drug combination is severe hyperkalemia, which is common when administering Angiotensin receptor blockers or ACE inhibitors together with a potassium-sparing diuretic (Machaj et al., 2019). This can lead to altering the patient’s treatment regimen to second-line therapy, which includes combining Neprilysin inhibitors like sacubitril with an angiotensin receptor blockers like valsartan. A cardiac glycoside like digoxin can also be used as second-line therapy. However, the patient can also use alternative medications like Sacubitril with losartan, inamrinone, digoxin, or minoxidil sacubitril is a Neprilysin inhibitor that helps in regulating blood volume. Finally, lifestyle changes and dietary interventions are also crucial in promoting the patient’s recovery process. Such lifestyle modifications include avoiding smoking, or drinking alcohol, exercising regularly, and sleeping for between 6 to 8 hours every night. Dietary interventions include consuming salt-restricted died, and avoiding fast foods, red meat, and fried foods.

References

Machaj, F., Dembowska, E., Rosik, J., Szostak, B., Mazurek-Mochol, M., & Pawlik, A. (2019). New therapies for the treatment of heart failure: a summary of recent accomplishments. Therapeutics and clinical risk management, 15, 147.  DOI: 10.2147/TCRM.S179302

Pellicori, P., Khan, M. J. I., Graham, F. J., & Cleland, J. G. (2020). New perspectives and future directions in the treatment of heart failure. Heart failure reviews, 25(1), 147-159. https://doi.org/10.1007/s10741-019-09829-7

Rossignol, P., Hernandez, A. F., Solomon, S. D., & Zannad, F. (2019). Heart failure drug treatment. The Lancet, 393(10175), 1034-1044. https://doi.org/10.1016/S0140-6736(18)31808-7

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Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.
Topic: Heart Failure
Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d.
Medical History:
His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years.
Medications:
His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver.
Diagnosis: Heart Failure Class II
1. List specific goals of treatment for Michael.
2. What drug(s) would you prescribe? Please provide rationales.
3. What are the parameters for monitoring the success of your selected therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. Describe one or two drug–drug or drug–food interactions for the selected agent(s).
6. List one or two adverse reactions for the selected agent(s) that would cause you to change therapy.
7. What would be the choice for the second-line therapy?
8. What over-the-counter or alternative medications would be appropriate for Michael?
9. What dietary and lifestyle changes should be recommended for Michael?