Elderly Patient Experiences Chest Pain and Shortness of Breath Due to Left Ventricular Failure – Symptoms Improve with Medication

At 86 years old, the female patient arrived at the hospital experiencing acute chest discomfort and difficulty breathing. Accompanied by excessive sweating and an inability to lie flat, her symptoms had persisted for two days without relief. After a thorough examination, she was diagnosed with left ventricular failure. Following a two-week course of intravenous medications including Deslanoside Injection, Furosemide Injection, and Nitroglycerin Injection, her condition significantly improved and stabilized.

Key Information

Patient: Female, 86 years old

Diagnosis: Left ventricular failure

Hospital: First Affiliated Hospital of Xi'an Jiaotong University

Visit Date: April 2022

Treatment Plan: Intravenous therapy (Morphine Hydrochloride Injection, Deslanoside Injection, Furosemide Injection, Nitroglycerin Injection) followed by oral medication (Digoxin Tablets, Furosemide Tablets)

Treatment Duration: Two weeks of hospitalization, one-month follow-up, and long-term monitoring

Outcome: Symptom relief and stable condition

Initial Assessment and Diagnosis

The patient reported experiencing chest pain and sudden shortness of breath two days prior to admission. Due to her age, her account of the symptoms was unclear, and her family was unable to provide a detailed history. Two hours before arrival, she developed severe dyspnea with profuse sweating and had to sit upright to breathe. There were no signs of nausea, vomiting, or altered consciousness.

Emergency electrocardiogram (ECG) results showed sinus tachycardia, abnormal Q wave (lead III), and complete right bundle branch block. Blood tests revealed elevated levels of cardiac biomarkers: troponin at 0.207 ng/ml, CK-MB at 4.7 ng/ml, and myoglobin at 126.7 ng/ml. Additionally, her B-type natriuretic peptide precursor (NT-proBNP) was over 35,000 pg/ml, indicating significant cardiac stress. Based on these findings, the medical team diagnosed left ventricular failure and admitted her for further treatment.

Therapeutic Approach and Management

Upon admission, the patient was placed in a semi-upright position with legs lowered to reduce venous return. Oxygen therapy and continuous cardiac monitoring were initiated immediately. Due to her advanced age and the high risks associated with surgical intervention, a conservative treatment plan was chosen after discussion with the family.

To alleviate her distress and improve breathing, Morphine Hydrochloride Injection was administered. To enhance cardiac function, Deslanoside Injection was used as a positive inotropic agent. Furosemide Injection was given to reduce preload by decreasing blood volume and relieving pulmonary congestion. Nitroglycerin Injection was employed to dilate blood vessels, thereby reducing both preload and afterload on the heart. Vital signs, urine output, and electrolyte levels were closely monitored throughout the treatment period.

Positive Response to Treatment

Prior to treatment, the patient's symptoms of chest pain and shortness of breath were severe and persistent. After two weeks of targeted medical therapy, she showed significant improvement. Her breathing was stable, and her heart rate returned to normal. Follow-up blood tests revealed a dramatic decrease in NT-proBNP levels to 89.7 pg/ml, with troponin at 0.03 ng/ml and myoglobin at 56.7 ng/ml, all within normal ranges.

With her condition stabilized, the patient was discharged with instructions to continue oral therapy with Digoxin and Furosemide. A one-month follow-up appointment was scheduled, and she was advised to seek immediate medical attention if any symptoms recurred.

Post-Discharge Care and Recommendations

While the patient's condition improved, the risk of deterioration remains. Therefore, adherence to prescribed medications and regular follow-ups every six months are essential. Given her age, it may be difficult for her to monitor her own health, so family members are encouraged to track her vital signs, including heart rate and blood pressure.

Dietary recommendations include low-sodium meals, smaller and more frequent meals, and careful fluid management. She should avoid crowded places or wear a mask to prevent infections that could worsen her condition. Rest is crucial, and she should avoid overexertion or staying up late.

Clinical Insights and Observations

This case highlights the typical presentation of left ventricular failure, including chest pain, orthopnea, and acute dyspnea. Other potential symptoms include coughing, frothy or pink-tinged sputum, fatigue, reduced urine output, and exertional breathlessness. In severe cases, patients may develop cardiogenic asthma or acute pulmonary edema.

It is crucial to recognize these signs early and seek medical evaluation. Elderly patients may not always report symptoms accurately, so caregivers must be vigilant. Prompt intervention can prevent progression and improve long-term outcomes for patients with left ventricular dysfunction.