Case study 1

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Assessment Task 2: Case study 1 – Harvey
Case
information 		Harvey, an 80-year-old male presents to the emergency department with
shortness of breath, cough and confusion.
His family members accompanied him and reported that in the weeks leading
up to his trip to the emergency department that Harvey had been feeling
tired, even upon the slighted exertion. He had not been able to complete
most of his normal activities. He also has a frequent cough, and his shortness
of breath was worse when he was lying on his back in his bed. Harvey even
mentioned coughing up frothy sputum at times.
Harvey’s medical history reveals a previous myocardial infarct following
occlusion of a branch of the left coronary artery at age 52 years. A blood test
at age 51 also revealed dyslipidaemia.
Physical examination revealed a blood pressure of 136/78 mmHg, a heart
rate of 109 beat/min, respiratory rate of 25 breaths/min and a body
temperature of 37°C. His height is 188 cm, weight is 90 kg. Only four weeks
prior his weight had been 87 kg. It is suspected that Harvey is presenting with
heart failure. A blood test taken in emergency revealed the following values:
Harvey’s fasting blood test results aged 80:

Parameter Harvey’s value Reference range
Sodium 143 mmol/L 135-145 mmol/L
Potassium 4.8 mmol/L 3.5-5.0 mmol/L
Calcium 2.05 mmol/L 2.15 – 2.60 mmol/L
Creatinine 140 µmol/L 45-90 µmol/L
eGFR 35 mL/min/1.73m2
Haemoglobin 103 g/L > 130 g/L
Research
Questions 		1. Define and briefly describe heart failure. Identify the most likely type
of heart failure he is experiencing.
2. Identify the most likely cause of his heart failure and explain the
pathophysiology underlying this.
3. Explain what dyslipidaemia is and explain how this might be linked
with the cause of his heart failure.
4. Explain the pathophysiology underlying his respiratory symptoms
(cough, dyspnoea).
5. Explain the pathophysiology underlying his symptoms of fatigue and
confusion.
6. Use his blood test results at age 80 to identify and explain which other
organ is most likely failing as a result of his heart failure.