I had a pt this week who was diagnosed with chronic CHF and dilated cardiomyopathi about 3 years ago. He was a heavy smoker for some time and quit about 10 months ago. When he quit smoking his SOB with activity lessened considerably. Now several months later he has become simptomatic againg with increased SOB, increased BP, and decreased activity intolerance. He recently had a weight gain of 10lbs in one week and had his lasix increased. At the same time his labs show a BNP of 85 and a CXRAY that showed no evidence of CHF or the dilated cardiomyopathi.
My questions are:
1. Do cardiac meds work well enough that a pt with chonic CHF would have a normal BNP and no evidence of CHF on a chest x-ray? (pts I've had in clinical in LTC all still had elevated BNP)
2. Is it possible that dilated cardiomypathi can be 'fixed'? I thought that was something that couldn't be 'cured' but the progression could be slowed.
3. If this pt's labs are all WNL and chest x-ray is neg for CHF and dilated cardiomyopathi, and a recent cardiogram showed an ejection fracture of 50% (when pt was diagnosed was only 26%!) why is this pt still so simptomatic?
Being a recent grad I kinda feel dumb because this doesn't make any sense to me! This probably should make sense - but it doesn't! I quess cardiac was always a weak subject for me. Any help would be appreciated! For some reason this is really bothering me and if I could get a clear explaination, well, that would help a lot!
And this pt was ambulatory dailly on his own prior to the change? C I guess without being trite at all, I would personally ask the doctor and you are trying to understand. I found NP's or the Docs very approachable. God luck!
Mommy TeleRN, RN
649 Posts
Has he had a cath or stress test? What is his rhythm? Having any CP with this SOB/activity intolerance?
Could have some blockages.