Cardiovascular Disorders Case Study: A Journey to Recovery from Congestive Heart Failure
Patient Information:
Age: 62
Gender: Male
Background: Retired government employee, lives with spouse, sedentary lifestyle, history of smoking
History or Cause:
Mr. Ramesh (name changed), a 62-year-old retired government employee, had become largely sedentary since retiring from his government job. He had a history of 30 years of smoking with little physical activity. Gradually, he started experiencing fatigue, shortness of breath, walking short distances, and intermittent chest pain that he initially dismissed as an "old age" issue.
Eventually, he experienced episodes of shortness of breath (which occurred often), swelling in his legs, and loss of appetite; he decided it was finally time to seek medical help.
Family members observed a noticeable decline in his energy levels and finally successfully encouraged him to go to see a doctor. After going to a cardiologist, additional investigations showed that Mr. Ramesh was suffering from congestive heart failure (CHF)—a chronic cardiovascular condition that occurs when the heart muscle doesn't pump blood as well as it should.
Diagnosis:
A thorough cardiovascular assessment was performed at Jagruti Rehab Centre that included:
- Electrocardiogram (ECG): Abnormalities of rhythm were noted.
- Echocardiogram: Total left ventricular ejection fraction (LVEF) calculated to be 30%, which demonstrated severely weakened heart muscle.
- Chest x-ray: Pulmonary congestion and mild cardiomegaly (enlarged heart) are seen.
- Bloodwork: BNP (B-type natriuretic peptide) was elevated, indicating heart failure.
- Stress testing and angiography: No significant obstruction was seen, leading to a diagnosis of a non-ischemic aetiology.
After considering all the information, Mr Ramesh was diagnosed with congestive heart failure (CHF), with reduced ejection fraction, likely from years of being hypertensive and poor lifestyle choices.
Treatment:
Our treatment at Jagruti Rehab Centre in Bangalore or any other location relied on multi-disciplinary rehabilitation addressing all of the physical, emotional, and lifestyle factors of having heart failure. We attempted, through intervention, to improve heart functioning, reduce had failure symptoms, and prevent future complications.
Program:
Acute interventions:
- Hospitalised to treat fluid overload.
- Administered controlled oxygen.
- Diuretic medication is needed to resolve swelling and breathlessness.
- Cardiac rehabilitation phase:
- Supervised exercise program (mild treadmill walking, stationary biking, moderate yoga).
- Heart-healthy nutrition education and counselling.
- Daily vital signs recording (BP, heart rate, oxygen saturation).
- Lifestyle modification sessions:
- Smoking cessation program.
- Mindfulness and breathing techniques to manage stress.
- Practicum on sleep hygiene and strategies to improve sleep quality.
Medical treatments:
- ACE inhibitors (Enalapril) reduce BP and decrease the workload on the heart.
- Beta-blockers (Metoprolol) to improve heart function and rhythm.
- Diuretics (Furosemide) to manage fluid overload.
- Indications for regular medication for BP and cholesterol.
Therapy:
- Psychoeducation sessions: address the patients' anxiety about health and resistance to lifestyle change.
- Group support sessions: They can talk to other people with cardiovascular issues.
- Family counselling sessions: family education on eating healthy, taking medication, and monitoring daily health.
Improvements / Recovery Timeline:
Week 1-2:
- Stability maintained in medication and fluid intake.
- Shin oedema was recorded as lessened along with significant improvement in breathing.
Weeks #3-4:
- The patient began light physical activity with supervision.
- The patient attended counselling for anxiety and some stress.
- The patient stopped smoking altogether.
Weeks #5-6:
- The patient demonstrated visible improvements in stamina.
- Blood Pressure areas had stabilised with less pronounced breathless episodes.
- The patient engaged in group yoga and relaxation therapy sessions.
Weeks #7-8:
- The echocardiogram showed some minor changes in LVEF measure and improved to 35%.
- The patient expressed confidence in her care, medication, and advanced meal-planning elements.
Weeks #9-12:
- The patient had begun guiding new entrants into the group.
- The patient continued to express an interest in continuing more home-based exercises.
- The patient has fully committed to attending future monthly follow-ups and joining the cardiac alumni support group sessions.
Challenges Faced During Treatment:
Although the rehabilitation program was established and structured, there were challenges Mr Ramesh faced in his rehabilitation journey.
Emotional Resistance to Change:
Mr Ramesh's first challenge was acknowledging the severity of his condition. He denied his symptoms and questioned the necessity for lifestyle changes such as restrictions in diet or changes in activity levels.
Poor Adherence to Medication:
In the first two weeks of discharge, the indications were that he sometimes failed to take his medications. He stated that he forgot and also experienced mild side effects, such as dizziness, as a reason for missing medications. For some of these reasons, a medication chart and a pill organiser for the medications prescribed to him were implemented.
Family Involvement:
Mr Ramesh's spouse was supportive. However, his kids were not as involved, partly due to their living in different cities. The distance created emotional distance initially, affecting Mr Ramesh's self-morale and energetic sacrifice. Family counselling and the addition of video participation in future meetings helped reduce some of this distance.
Financial Burden:
One of the hang-ups for these families was the longer-term management of medications, continuous testing, and appointments, which can become a financial burden. Our social worker was able to help the family access affordable healthcare and support under government schemes.
These challenges were gradually resolved through counselling, individual care, and community support through the rehabilitation program.
Our Success:
Mr. Ramesh moved from deterioration to hopefulness. Cardiovascular function was starting to show improvement, and he was again able to complete tasks of daily living, including walking to the park or walking to help with chores around the home and spending time with his friends.
His mental attitude was different as well—he was more conscious of his health, committed to continuing his regular medication, and continued to do workouts at home to strengthen and condition his body.
Family and Community:
He was also a catalyst for change in his family. His wife and older son bought into the dietary and medication routines, so they were improving their lifestyles at home as well. There were many neighbours and friends who began asking for advice about strength and conditioning for cardiovascular prevention as he improved in his health.
Lessons Learned:
Mr Ramesh's case provides some important lessons for healthcare professionals and patients dealing with cardiovascular disease:
Early Diagnosis is Life Saving:
Patients frequently minimise the symptoms of cardiovascular disease until it is too late. If we are more timely with diagnosis, we can limit complications and greatly improve prognosis.
Comprehensive Treatment is Vital:
Treating just the cardio condition, and not the patient's emotional state, social situation, or behaviour, will impact long-term recovery. A good rehabilitation program will include not only physical recovery but psychological recovery and the inclusion of lifestyle changes.
Family is Integral for Recovery:
Involving the family and providing them with education is essential. When the family is supportive, the patient is much more likely to comply, and emotional stability will be established.
Individualised Rehabilitation is Better:
Patients vary in their backgrounds, obstacles, and responses to treatment. When we can personalise the rehabilitation program, patients will trust us more and engage better in their program.
Importance of the Community and Peer Support:
Having the patients meet with others who are in similar situations helps them feel less isolated. Support peer groups can encourage them to stay on track through accountability.
Bottom Line
This case study of the cardiovascular disorders of Mr Ramesh demonstrates how timely intervention, structured rehabilitation and family support can show great results in a patient suffering from congestive heart failure. Our Jagruti Rehab Centre continues to provide him with support and check-ins while motivating and continuing his journey as a success and beacon of recovery for others with similar health issues.
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