improving the heart’s pumping action
The goal of the treatment is to enhance cardiac output by improving the heart’s pumping action and reducing the heart’s workload. Aldosterone antagonist: Spironolactone 25 milligrams once: Affects the production of aldosterone hormone in the kidney, increasing the water retention in the kidney. Consequently, it reduces the pitting leg edema and the water retained around the cardiac muscle due to congestive heart failure (Zaragoza, Zaidi, Dendukuri, & Marelli, 2019). Other recommendations include sleeping in a fowler’s position to maintain orthopnea. The patient should also treat the underlying conditions which include MI and CHF which can clear the respiratory system and allow for easy breathing (Jneid, Bozkurt, & Fonarow, 2018).
angiotensin-converting enzyme
Given the lower-leg swelling, which is due to pitting edema (Osteoarthritis), it is essential to reduce the workload for the heart. The patient should use an angiotensin-converting enzyme (ACE), most preferably Captopril, 50 mg per dosage, three doses a day. Given the patient’s 160/92 blood pressure reading, the patient requires treatment for hypertension (Zaragoza, Zaidi, Dendukuri, & Marelli, 2019). Valsartan, an angiotensin receptor blocker, dilates the blood vessels and reduces the load for the heart. It also reduces blood pressure. The patient should take 20 mg twice a day. It is essential in the treatment of hypertension. It should be taken alongside Sacubitril, which is an Angiotensin Receptor-Neprilysin Inhibitors. She should take 20 mg twice.
The patient also needs medication for her MI condition. Other than resolving the pitting edema, the ACE recommended (three doses of Captopril, 50 mg per dosage) also works in maintaining the genetically inherited myocardial infarction by reducing their mortality (Jneid, Bozkurt, & Fonarow, 2018). The effect in reducing the mortality of myocardial infarctions is seen in the first 30 days, therefore requires the patient to have sufficient dosage to last over a month. In addition to ACE recommended for MI, the patient should also take Glyceryl trinitrate, which leaves the coronary arteries open, thus reducing the heart’s workload. The patient should take 500 micrograms a day (Jneid, Bozkurt, & Fonarow, 2018). The patient should also stop drinking wine or any alcoholic beverage. Self-care, including exercise and reduction of carbohydrates and fats, are recommendations for the patient’s obesity concern.
References
Jneid, H., Bozkurt, B., & Fonarow, G. C. (2018). The 2017 AHA/ACC performance and quality measures for patients with acute myocardial infarction. JAMA cardiology, 3(7), 659-660.
Zaragoza-Macias, E., Zaidi, A. N., Dendukuri, N., & Marelli, A. (2019). Medical therapy for systemic right ventricles: a systematic review (part 1) for the 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(12), 1564-1578.
