Cardiothoracic ratio = (MRD + MLD) / ID
MRD = greatest perpendicular diameter from midline to right heart border
MLD = greatest perpendicular diameter from midline to left heart border
ID = internal diameter of chest at level of right hemidiaphragm
1. What is the significance of the findings of the chest X- Ray?
Ans : The findings of chest X-ray suggests about the cardiomegaly condition of the patient which helped in the diagnosis of the condition of Congestive Heart Failure.
**Due to progressive CHF condition, all the above
symptoms were arising to Mrs. JE.
2. Is there any Drug interaction,
that should be taken in consider?
Ans : There is moderate drug interaction between :
a. Furosemide + Digoxin
Furosemide increases effects of digoxin
by pharmaco-dynamic synergism.
Hypokalemia increases digoxin effect.
***Potassium is prescribed to overcome
the hypokalemic condition
b. Enalapril + Furosemide
Risk of acute hypotension, renal insufficiency
due to pharmacologic synergism.
***Sodium is prescribed.
c. Enalapril + Digoxin
Enalapril increases the effect of digoxin by unspecified mechanism.
However, it is suggested to monitor the dose and side effects closely, and above all the combination are suggested to have better efficacy in elderly patients while monitoring closely.
*****Decrease the potassium in diet as needed.
3. Are there any collaborative problems that has been
*MI – CONSIDERED
DYSPNEA – CONSIDERED
EDEMA IN LEGS – CONSIDERED
CRACLE IN LUNGS & PEREFERRAL CYANOSIS – CONSIDERED
SHORTNESS OF BREATH – CONSIDERED
SLEEPING STYLE CONSIDERED – CONSIDERED
RTI – CONSIDERED (But SPUTUM TEST should
be performed for the assurance of the cause of the infection)
*Except MI , these all have considered to have arose due to progressive congestive heart failure.
4. Is Mrs. JE provided with appropriate drug regimen? Justify.
Ans: All the drugs are provided with low or moderate dose which is the suggested treatment plan for elderly patients having congestive heart failure (which can be further increased according to the condition of patient.)
**Oշ has been provided while considering the low Oշ saturation in blood (peripheral cyanosis).