### Concept Map Template
#### Primary Diagnosis: Congestive Heart Failure (CHF)
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**1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?**
**Pathophysiology of Primary Diagnosis:**
Congestive Heart Failure (CHF) occurs when the heart is unable to pump sufficient blood to meet the body’s needs. This inefficiency leads to a backup of blood in the veins and an accumulation of fluid in tissues and organs (edema). The condition can result from damage to the heart muscle due to coronary artery disease, hypertension, myocardial infarction, or cardiomyopathy. Over time, the heart becomes weakened and stiff, reducing its ability to fill and pump effectively.
**Causes:**
– Coronary artery disease
– Hypertension
– Myocardial infarction
– Cardiomyopathy
– Valvular heart disease
– Arrhythmias
**Risk Factors (genetic/ethnic/physical):**
– Age (more common in older adults)
– Family history of heart disease
– Hypertension
– Diabetes
– Obesity
– Sedentary lifestyle
– Smoking
– Excessive alcohol consumption
– African American ethnicity has a higher prevalence of CHF
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**2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?**
**Signs and Symptoms – Common Presentation:**
– Shortness of breath (dyspnea)
– Fatigue and weakness
– Edema (swelling) in legs, ankles, and feet
– Rapid or irregular heartbeat
– Persistent cough or wheezing with white or pink blood-tinged phlegm
– Increased need to urinate at night
– Swelling of the abdomen (ascites)
– Rapid weight gain from fluid retention
– Lack of appetite and nausea
**How does the diagnosis impact each body system? Complications:**
– **Cardiovascular System:**
– Complications include arrhythmias, myocardial infarction, and increased risk of stroke.
– **Respiratory System:**
– Pulmonary congestion and edema leading to shortness of breath and respiratory distress.
– **Renal System:**
– Reduced kidney perfusion leading to renal insufficiency or failure.
– **Gastrointestinal System:**
– Liver congestion leading to hepatomegaly and ascites, as well as gastrointestinal edema causing nausea and anorexia.
– **Musculoskeletal System:**
– Fatigue and weakness impacting mobility and physical function.
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**3. What are other potential diagnoses that present in a similar way to this diagnosis (differentials)?**
– Chronic obstructive pulmonary disease (COPD)
– Pulmonary embolism
– Acute kidney injury or chronic kidney disease
– Cirrhosis with ascites
– Severe anemia
– Thyroid disorders (hyperthyroidism or hypothyroidism)
– Valvular heart disease
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**4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?**
**Diagnostic Tests and Labs:**
– **Echocardiogram:** To assess heart function, structure, and ejection fraction.
– **Chest X-ray:** To check for fluid in the lungs and size of the heart.
– **Electrocardiogram (ECG):** To identify arrhythmias, myocardial infarction, or ischemia.
– **B-type Natriuretic Peptide (BNP) or N-terminal pro b-type Natriuretic Peptide (NT-proBNP):** Elevated levels indicate heart failure.
– **Complete Blood Count (CBC):** To rule out anemia.
– **Renal function tests:** To assess kidney function.
– **Liver function tests:** To check for liver congestion.
– **Thyroid function tests:** To rule out thyroid disorders.
– **Pulmonary function tests:** To differentiate from COPD.
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**5. What treatment options would you consider? Include possible referrals and medications.**
**Treatment Options:**
**Medications:**
– **Diuretics:** To reduce fluid overload (e.g., furosemide).
– **ACE Inhibitors or ARBs:** To reduce cardiac workload and blood pressure (e.g., lisinopril, losartan).
– **Beta-blockers:** To control heart rate and reduce blood pressure (e.g., metoprolol).
– **Aldosterone antagonists:** To further reduce fluid retention (e.g., spironolactone).
– **Digoxin:** To improve heart contractility.
**Possible Referrals:**
– **Cardiologist:** For specialized heart failure management.
– **Pulmonologist:** If there are significant respiratory complications.
– **Nephrologist:** If there is renal involvement or dysfunction.
– **Dietitian:** For dietary counseling to manage fluid and salt intake.
– **Physical Therapist:** To aid in improving physical function and endurance.
– **Social Worker:** For support with lifestyle changes and accessing resources.
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**References:**
– McMurray, J. J. V., et al. (2019). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 41(3), 212-271.
– Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology, 70(6), 776-803.
– Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation, 145(18), e895-e1032.
Concept Map Template
Primary Diagnosis: ___________________________________________________________
1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| Causes | Risk Factors (genetic/ethnic/physical) |
2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
3. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
5. What treatment options would you consider? Include possible referrals and medications.
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