Explain the pathophysiology of Richard’s elevated heart rate.

Student Handout for Case Study: Heart Failure
Directions: Read the following case study and complete the questions. Provide at least 2 references to support answers.
Richard, age 72, has reported to the emergency department complaining of chest pain. His breathing is slightly labored, with a respiratory rate of 18 breaths per minute. He appears pale and anxious.
Richard’s heart rate is 122 beats per minute, and his blood pressure, with anti-hypertensive medications, is 158/88 mm Hg.
Richard complains that he has been having problems breathing, especially at night, and must sleep “propped up.” Auscultation reveals the presence of pulmonary crackles.
ECG and echocardiogram results indicate left ventricular hypertrophy. Pulmonary capillary wedge pressure is elevated. In addition, jugular vein distention, peripheral edema, and enlargement of the liver are noted.
1. Explain the pathophysiology of Richard’s elevated heart rate.
2. What may account for Richards’s difficulty breathing, especially at night? Please be specific.
3. What is the pathophysiological significance of the left ventricular hypertrophy and the fact Richard is on antihypertensive medications?
4. What is the significance of the jugular vein distention, peripheral edema, and liver enlargement? Explain the pathophysiology of each.
5. What do you expect to be the diagnosis for Richard?
6. What are some treatment options for Richard?

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