Title: A Case Study on a 74-Year-Old Woman with Shortness of Breath and Swelling: Understanding the Diagnosis and Treatment of Heart Failure

Answer the questions below in paragraph form and use the sample essay as a guide. Make sure to answer each question in at least a paragraph per question. Make sure to add in text citations as well as a title page and reference page at the end as well. 
Also please include 10 references for this case study. 
Chief Complaint: 74-year-old woman with shortness of breath and swelling.
History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever
while in her twenties, presented to her physician with complaints of increasing shortness
of breath (“dyspnea”) upon exertion. She also noted that the typical swelling she’s had
in her ankles for years has started to get worse over the past two months, making it
especially difficult to get her shoes on toward the end of the day. In the past week, she’s
had a decreased appetite, some nausea and vomiting, and tenderness in the right
upper quadrant of the abdomen.
On physical examination, Martha’s jugular veins were noticeably distended. Auscultation
of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left
upper sternal border. In addition, she had an extra, “S3” heart sound.
Questions:
1. What is causing this murmur?
2. What is causing her “S3” heart sound?
3. Is her history of rheumatic fever relevant to her current symptoms? Explain.
4. A chest X-ray reveals a cardiac silhouette that is normal in diameter. Does this rule
out a possible problem with Martha’s heart? Explain.
5. You examine Martha’s abdomen and find that she has an enlarged liver
(“hepatomegaly”) and a moderate degree of ascites (water in the peritoneal cavity).
Explain these findings.
6. Examination of her ankles reveals significant “pitting edema.” Explain this finding.
7. She is advised to wear support stockings. Why would this help her?
8. Which term more accurately describes the stress placed upon Martha’s heart —
increased pre-load or increased afterload?
9. What is the general term describing Martha’s condition?
10. How might Martha’s body compensate for the above condition?
11. Martha is started on a medication called digoxin. Why was she given this
medication, and how does it work?
12. Two weeks after starting digoxin, Martha returns to the physician’s office for a
follow-up visit. On physical examination, she still has significant hepatomegaly and
pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her
physician prescribes a diuretic called furosemide (or “Lasix”). Why was she given this