Elderly Man Suffers from Chronic Heart Failure, Treatment Relieves Symptoms of Chest Tightness and Shortness of Breath
In this case study, we follow the journey of a 68-year-old male patient who sought medical attention due to worsening symptoms of chest tightness, shortness of breath, and lower limb swelling. Upon examination and diagnostic testing at the First Affiliated Hospital of Anhui Medical University, he was diagnosed with chronic congestive heart failure. With a comprehensive treatment plan including diuretics and cardiac support medications, the patient experienced significant improvement in symptoms and overall health after 12 days of hospitalization and three months of outpatient follow-up.
Case Overview
Patient: Male, 68 years old
Diagnosis: Chronic Heart Failure
Hospital: First Affiliated Hospital of Anhui Medical University
Date of Admission: January 2022
Treatment: Combination drug therapy including digoxin, metoprolol succinate, furosemide, spironolactone, sacubitril/valsartan, rivaroxaban, and nitroglycerin
Treatment Duration: 12 days of inpatient care followed by 3 months of outpatient monitoring
Outcome: Significant reduction in chest discomfort, improved breathing, and increased physical tolerance
Initial Presentation and Diagnosis
The patient presented in January 2022 with noticeable shortness of breath and fatigue. He reported experiencing intermittent chest tightness and breathlessness for over a decade, typically triggered by physical exertion. However, over the past three years, symptoms had worsened, occurring even with mild activity such as walking quickly or climbing stairs. Despite previous diagnoses of heart failure and temporary symptom relief through diuretics and other medications, the patient had not maintained consistent medication use after discharge.
In the past three days before admission, symptoms had significantly increased, including difficulty lying flat at night, leg swelling, poor appetite, and trouble sleeping. Upon physical examination, his pulse was elevated at 104 beats per minute, respiratory rate at 24, and blood pressure at 140/82 mmHg. Signs of fluid overload were evident, including jugular venous distension, bilateral lower lung crackles, and moderate pitting edema in both legs.
Diagnostic tests confirmed the severity of the condition. Blood work showed elevated BNP levels at 1883.88 pg/ml, an indicator of heart strain. An ECG revealed rapid atrial fibrillation, and echocardiography showed enlarged atria, left ventricular dysfunction, and an ejection fraction of 42%. A chest CT scan also detected small bilateral pleural effusions. These findings led to a definitive diagnosis of chronic heart failure.
Treatment Plan and Medication Approach
Following a detailed discussion with the patient and family regarding the risks and benefits of treatment, the patient agreed to proceed with a comprehensive pharmacological strategy. Immediate treatment included:
- Furosemide: To promote diuresis and reduce fluid buildup
- Spironolactone: For potassium-sparing diuresis and prevention of ventricular remodeling
- Nitroglycerin: To reduce cardiac preload and afterload
- Digoxin: To strengthen myocardial contractility and slow ventricular rate
- Sacubitril/Valsartan: To inhibit the RAAS system and reverse cardiac remodeling
- Metoprolol Succinate: To control heart rate and reduce myocardial oxygen demand
- Rivaroxaban: For anticoagulation to prevent thromboembolic events
Progress and Recovery
On the day of admission, the patient began treatment with furosemide, spironolactone, nitroglycerin, and digoxin. Within two days, symptoms of breathlessness improved, although physical endurance remained limited. Further testing led to the addition of rivaroxaban, sacubitril/valsartan, and metoprolol succinate to the regimen. By the 12th day, the patient was free of significant chest tightness or shortness of breath, could lie flat comfortably, and had reduced edema. He was cleared for discharge with instructions for regular follow-up visits including kidney and liver function tests, coagulation profiles, ECGs, and echocardiograms. Dosage adjustments were planned to optimize long-term outcomes.
Ongoing Care and Lifestyle Management
While the patient's condition improved significantly during hospitalization, post-discharge care is equally critical for long-term stability. Dietary modifications are essential, including reduced sodium intake and avoidance of high-fat, high-sugar foods. A balanced, plant-rich diet supports both heart health and electrolyte balance.
Patients on long-term diuretics should monitor urine output and color and ensure adequate potassium intake. Regular outpatient checkups help detect early signs of electrolyte disturbances. In addition, consistent monitoring of blood pressure and heart rate, along with stress management, can help maintain cardiovascular stability. Any recurrence of chest discomfort or breathlessness should prompt immediate medical attention to prevent deterioration.
Clinical Insights on Chronic Heart Failure
Chronic heart failure represents the end stage of various cardiovascular diseases. Its hallmark is progressive decline in cardiac function, often seen in older adults with comorbidities such as hypertension or ischemic heart disease. Patients typically present with worsening dyspnea and fatigue, which can escalate quickly without prompt intervention.
Acute decompensation requires urgent medical attention to stabilize the patient and prevent life-threatening complications such as sudden cardiac death. Even in stable, chronic phases, long-term adherence to prescribed medications and lifestyle changes is crucial for improving survival and quality of life. This case highlights the importance of early diagnosis, tailored treatment, and continuous follow-up in managing heart failure effectively.