Case-3 Answers

Cardiothoracic ratio = (MRD + MLD) / ID

where:

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

not considered?

Ans:

*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).

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