Case study of an ischemic heart disease patient

Ischemic heart disease and breathlessness Ischaemic Heart Disease occurs when the blood flow to the heart muscle is reduced because of a partial or complete blockage of the coronary arteries. One possibility of shortness of breath in these patients is related to ischemia—less blood flow to the heart muscle. Dyspnoea and breathlessness could be differential diagnostic symptoms to chest pain in ischemic heart disease but may also precede angina pectoris as a manifestation of IHD. CPAP can improve oxygenation and ventilation in such patients. Brief of case study: A 64-year-old male who is a known case of ischemic heart disease was admitted with a complaint of severe breathlessness. Present complaint: The patient confirmed that he cannot walk uphill without getting breathless and has noticed that he gets up twice or thrice in the night because of feeling “out of breath”. Medical history: K/C/O Ischemic heart disease Undergone coronary angioplasty 7 years back A previous echo reported EF of 25% with grade 1 diastolic dysfunction Physical examination: Pedal edema Pulse rate – 132/min SpO2 saturation – 92% No history of fever or productive sputum Diagnosis: Grade 1 diastolic dysfunction with ischemic heart disease Treatment: The patient was admitted to the intensive care unit and was immediately placed on non-invasive ventilation. The patient reported an improvement in his breathlessness. The heart rate reduced by 20% and the oxygenation improved. Discussion: Continuous positive airway pressure (CPAP) increases the inspiratory flow. This might help in increasing the tidal volume and in unloading the inspiratory muscles thus reducing the work of breathing. This helps to unload the inspiratory muscles and the diaphragm to some extent reducing the dyspnoea and hence the patient can breathe more comfortably.1 In fact, CPAP improves the sensation of comfort, reduces inspiratory work of breathing, and increases flow in the late…

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