CONSIDER THE HEART FAILURE CASE STUDY BELOW Initial Presentation… CONSIDER THE HEART FAILURE CASE STUDY BELOWInitial PresentationPatient is a 66-year-old white male. He complains of shortness of breath over the past month and states it has been getting worse. He states his ankles have been swollen in the evening and he has gained five pounds in the last week. He works as a carpenter.Additional History16-year history of hypertensionMI and subsequent triple vessel coronary artery bypass grafts five years agoHis current medications are metoprolol tartrate 50 mg twice a day, simvastatin 40 mg daily each evening, and enteric-coated aspirin 81 mg dailyTwo-pack per day smoker, occasional beer on the weekendsFamily HistoryMarried with two children. Both parents are deceased. Mother had a history of hypertension, diabetes, and stroke. Father had two MIs and died of colon cancer. Three younger brothers, all living; two have hypertension (aged 58 and 62), the third sibling had an angioplasty with coronary stent placement last year at age 55.Lab/Diagnostic ResultsVital signs: T 37.2 °, BP 126/82, P 102, RR 26 (increases with activity)Chemistries: Serum sodium and chlorides are slightly decreasedWBC 7.8HCT 36%BNP 570Chest X-ray reveals cardiomegalyMedicationsHe is placed on a thiazide diuretic (hydrochlorothiazide) and an ACE inhibitor but is unable to tolerate the ACE inhibitor. He is then prescribed valsartan, an angiotensin II receptor blocker (ARB), and asked to follow up in two weeks. S1.  What is the major cellular dysfunction contributing to the pathology? (Heart failure; focus on fluid volume abnormalities and the role of angiotensin.) 2.  Of the information listed in the patient history or laboratory and diagnostic results, which are typical for the pathology of heart failure? How does the identified class of medication relate to the pathophysiology of heart failure on a cellular level? Be prepared to discuss pharmacodynamics and pharmacokinetics.  3.  What will be observed to confirm a therapeutic response?          Health Science Science Nursing NRS NRS526

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