1. Read the case study below.
  2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
  3. Respond to at least one peer and all faculty questions directed at you, using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario:

A 72-year-old male presents to the primary care office with shortness of breath, leg swelling, and fatigue. He reports that he stopped engaging in his daily walk with friends three weeks ago because of shortness of breath that became worse with activity. He decided to come to the office today because he is now propping up on at least 3 pillows at night to sleep. He tells the NP that he sometimes sleeps better in his recliner chair. PMH includes hypertension, hyperlipidemia and Type 2 diabetes.

Physical Exam:

BP 106/74 mmHg, Heart rate 110 beats per minute (bpm)

HEENT: Unremarkable

Lungs: Fine inspiratory crackles bilateral bases

Cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd heart sound; jugular venous distention. Bilateral pretibial and ankle 2+pitting edema noted

ECG: Sinus rhythm at 110 bpm

Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection fraction of 25%

Diagnosis: Heart failure, secondary to silent MI

Discussion Questions:

  • Differentiate between systolic and diastolic heart failure.
  • State whether the patient is in systolic or diastolic heart failure.
  • Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.
  • Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%.


  • Differentiate between systolic and diastolic heart failure.

     Systolic heart failure (HF) or heart failure with reduced ejection fraction (HFrEF) is when the left ventricle loses the ability to contract efficiently and the heart does not have enough force to push blood adequately to circulate throughout the body (AHA, 2021). As a result, the ejection fraction (EF) is reduced to being below 40% due to the heart being unable to generate cardiac output to perfuse the body’s vital tissues (McCance & Huether, 2019). Cardiac output is dependent on the stroke volume and heart rate (HR), therefore, if the stroke volume isn’t sufficient it can decrease the contractility, preload, and afterload. As a result, this can develop into ventricular remodeling, myocardial infarction (MI), myocarditis, and cardiomyopathies. HFrEF affects primarily males. The left ventricular ejection fraction (LVEF) decreases while the left ventricle chamber size increases (McCance & Huether, 2019). Upon auscultation, an S3 gallop will be heard and chest radiography will display pulmonary congestion with cardiomegaly (McCance & Huether, 2019)….Kindly click the purchase icon to purchase the full solution at $10