Alterations in the Cardiovascular and Respiratory Systems Assignment

Alterations in the Cardiovascular and Respiratory Systems Assignment

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Alterations in the Cardiovascular and Respiratory Systems

The cardiovascular disease system leads to the frequent confrontation of the physician as they do their daily activity in personal care. However, a critical review of the knowledge associated with the pathophysiologic process linked to heart diseases. 45 years old woman was presented with a chief complaint of the 3-day duration of shortness of breath, fevers, and cough with sputum production. The patient also presented a history of COPD with a chronic cough which had gotten worse, interfering with sleep. The sputum had gotten thinker, limiting her expectorate. In addition, the CXR showed that the patient had an increase in AP diameter, which revealed a flattened diaphragm. Based on Auscultation, the patient also demonstrated coarse rales, rhonchi, and hyper resonance in the lung field. The paper examines the case study by analyzing the symptoms presented, diagnosis, and the implication to the patient health.

Cardiovascular and Cardiopulmonary Pathophysiologic Processes

Chronic obstructive pulmonary disease (COPD) is caused by the obstruction of the air in the lungs (McCance et al., 2019). Therefore, the chronic inflammatory response on either gases or noxious particles is led by the chronic inflammatory response. The known common causes of COPD are smoking and airway hyperresponsiveness, heredity, and asthma (McCance et al., 2019). The mechanisms that occur are fibrosis and the inflammation of the bronchus, and the loss of the elastic lung fibers. In addition, hypertrophy of the submucosal glands is involved, thus causing the mismatch of the perfusion and the ventilation.

There are two major types of chronic obstructive pulmonary disease which include Chronic Bronchitis and Emphysema. Emphysema is caused by shortness of breath (McCance et al., 2019). For patients facing the Emphysema lung condition, the air sacs are damaged. The increase in the air spaces in the inner walls eventually ruptures after weakening (McCance et al., 2019). Therefore, the first sign that one detects for a patient with Emphysema is shortness of breath and a persistent cough with phlegm.

Chronic Bronchitis is caused by the small airways and the obstruction of the airways. The problem is most commonly faced by smokers and people at a high risk of contracting a lung infection (McCance et al., 2019). The symptoms include shortness of breath, muscle aches, nasal congestion, and wheezing. The hypersecretion of the mucus and inflammation made a patient produce thick green sputum, rhonchi, and rales upon Auscultation (McCance et al., 2019).

The diaphragm flattening is caused by hyperinflation of airways to a patient leading to an increase in the Anteroposterior (AP) diameter. The main cause of diaphragm flattening is the air trapping and the abnormal enlargement of the airspaces (Victory et al., 2020). In addition, the cardiovascular system can be mismatched by the ventilation-perfusion, causing a strain to a patient. The COPD patients’ demand for oxygen increases due to low-level absorption and diffusion in the body (Victory et al., 2020).

Therefore, the heart works harder in ensuring that the oxygen is pushed in different organs while the body picks up the signal. The task of pumping oxygen into the body and other organs becomes tough, leading to hypertrophy of the heart muscles (Victory et al., 2020). The complication is known as heart failure. The cardiopulmonary effect makes it easy to identify patients with COPD since they get tired and experience shortness of breath when undertaking strenuous activities (Victory et al., 2020).

Racial/Ethnic Variables that May Impact Physiological Functioning

Black Americans are at a high risk of hospitalization compared to Whites (Mamary et al., 2018). Among the patients in emergency room visits, fewer Black regularly have a schedule with a physician (Stellefson et al., 2021). In this case, a prolonged period of smoking, comorbidity, and a rise in the normal body mass cause an increase in the rate of hospitalization among Black Americans (Stellefson et al., 2021). Compared to non –Hispanic Whites, Black Americans are at a high risk of being admitted to the Intensive Care Unit (ICU) due to mechanical ventilation. This shows that Black Americans are more vulnerable to the exacerbation of severe COPD.

How these Processes Interact to Affect the Patient

The common cause of the chronic obstructive pulmonary disorder is due to smoking. The effect occurs in the lungs hindering the inflammation of the airways. In addition, smoking causes damage to the alveolar walls and disrupts the hyperactive based on the secretion of mucus (Elisha et al., 2019). As a result, one faces shortness of breath and an increase in the Anteroposterior (AP) diameter and experiences the hyperresonance of the lung fields (Elisha et al., 2019). Therefore, a patient faces the risk of poor quality of life, which causes fatigue and sleep, thus interfering with daily life.

Conclusion

Chronic obstructive pulmonary disease (COPD) is caused by the obstruction of the airflow in the lungs. The major symptom for a patient with COPD include wheezing; the sputum gets thick and harder. In addition, a patient is likely to complain of coarse rales and rhonchi in all the lung fields.

References

Elisha, S., Nagelhout, J. J., & Heiner, J. S. (2019). Current Anesthesia Practice: Evaluation & Certification Review. Elsevier Health Sciences.

Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., … & COPDGene® Investigators. (2018). Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 5(3), 177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296789/

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (Eds.). (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.

Stellefson, M., Wang, M. Q., & Kinder, C. (2021). Racial Disparities in Health Risk Indicators Reported by Alabamians Diagnosed with COPD. International Journal of Environmental Research and Public Health, 18(18), 9662. https://www.mdpi.com/1660-4601/18/18/9662

Victory, L. R., Ervin, K. M., & Ridge, C. A. (2020). Imaging in chest disease. Medicine, 48(4), 249-256.

Pathophysiology

Cardiovascular and cardiopulmonary diseases are characterized by insufficiency in the blood supply to all parts of the body. In this case, the patient presented with shortness of breath and pleuritic chest pain on palpitation which could be attributed to a lack of enough oxygen supply in the lungs (Lefevre-Scelles et al., 2020). An embolism refers to the blockage in one of the arteries due to a blood clot of accumulation of fats (Kaptein et al., 2021). The condition results in inflammation in the pleural membrane that causes sharp and intense pain. The shortness of breath is due to a lack of enough oxygen in the body (Ishaaya & Tapson, 2020).

Genetic factors influence the risk of cardiovascular and cardiopulmonary diseases. The burden of the disease is high among African Americans due to variants in the ARMC5 gene (Zilbermint et al., 2018). The rs116201073 variant is common among blacks and contributes to their increased risk for cardiovascular disease (Zilbermint et al., 2019).

The race of the patient is not indicated; however, immobility and old age could have contributed to the development of the symptoms. The atrial fibrillation in the ECG report indicates a failure in the heart muscles due to the strain caused by an embolism (Ahmed & Zhu, 2020).

Conclusion

The case involves patients with symptoms of pulmonary embolism. The heart strains because of the increased demand for oxygen supply. The pain experienced by the patient result from both inflammation and lack of oxygen.

References

Ahmed, N., & Zhu, Y. (2020). Early detection of atrial fibrillation based on ECG signals. Bioengineering, 7(1), 16. https://doi.org/10.3390/bioengineering7010016

Ishaaya, E., & Tapson, V. F. (2020). Advances in the diagnosis of acute pulmonary embolism. F1000Research, 9, 44. https://doi.org/10.12688/f1000research.21347.1

Kaptein, F., Kroft, L., Hammerschlag, G., Ninaber, M., Bauer, M., Huisman, M., & Klok, F. (2021). Pulmonary infarction in acute pulmonary embolism. Thrombosis Research, 202, 162-169. https://doi.org/10.1016/j.thromres.2021.03.022

Lefevre-Scelles, A., Jeanmaire, P., Freund, Y., Joly, L., Phillipon, A., & Roussel, M. (2020). Investigation of pulmonary embolism in patients with chest pain in the emergency department: A retrospective multicenter study. European Journal of Emergency Medicine, 27(5), 357-361. https://doi.org/10.1097/mej.0000000000000680

Moonesinghe, R., Yang, Q., Zhang, Z., & Khoury, M. J. (2019). Prevalence and cardiovascular health impact of family history of premature heart disease in the United States: Analysis of the national health and nutrition examination survey, 2007–2014. Journal of the American Heart Association, 8(14). https://doi.org/10.1161/jaha.119.012364

Zilbermint, M., Gaye, A., Berthon, A., Hannah-Shmouni, F., Faucz, F., Minority, H. N., Davis, A., Gibbons, G., Lodish, M., & Stratakis, C. (2018). ARMC5 variants and risk of hypertension in African Americans: Minority Health-GRID study. Endocrine Abstracts. https://doi.org/10.1530/endoabs.56.oc10.3

Zilbermint, M., Gaye, A., Berthon, A., Hannah‐Shmouni, F., Faucz, F. R., Lodish, M. B., Davis, A. R., Gibbons, G. H., & Stratakis, C. A. (2019). ARMC5 variants and risk of hypertension in blacks: MH‐GRID study. Journal of the American Heart Association, 8(14). https://doi.org/10.1161/jaha.119.012508

The assigned case study demonstrates a middle age female patient with chief complaints of dyspnea, fever, and cough with thick green sputum production for 3 days. The patient also has a history of COPD and chronic cough, which has gotten worse over the past few days affecting her sleep. Upon examination, it was noted that the patient’s diaphragm had flattened, AP diameter increased, hyper resonance on auscultation with rhonchi, and coarse rales throughout all lung fields. The purpose of this discussion is to provide an analysis of the patient described above and the cardiovascular and cardiopulmonary pathophysiologic processes that contributed to the patient’s symptoms.

Pathophysiologic Processes

The patient presents with a history of COPD and chronic cough with thick green sputum. The current symptoms of dyspnea, cough, and fever indicate exacerbation of COPD with complications of a respiratory infection (Hikichi et al., 2018). The patient’s shortness of breath resulted from the obstructed airways secondary to inflammation, sputum hypersecretion, and airway remodeling. Reduced elastic recoil of the lung caused by emphysema and airway obstruction leads to dynamic hyperinflation and incomplete air expelling (Santus et al., 2019). Accumulation of the mucus leads to coughing by the patient as an attempt to try and clear the airways. The increased production of thick green sputum and fever are signs of bacterial infection in COPD exacerbation.

Racial/Ethnic Variables

            There is limited evidence on the racial/ethnic variables in the characteristics and progress of COPD. Non-Hispanic whites have however been reported to have the highest burden associated with symptoms of chronic bronchitis and cardiovascular diseases as comorbidities of COPD (Park et al., 2021). African Americans on the other hand, have reported the highest incidences of dyspnea due to lifestyle habits like smoking and reduced exercise capacity (Lee et al., 2018). Korean patients on the other hand were more likely to be underweight as compared to other ethnic groups, hence reduced COPD symptoms and complications (D’Cruz et al., 2020). Generally, the ethnic variables in COPD are due to sociodemographic differences in lifestyle habits, education, and cultural beliefs among other factors.

How Process interact to Affect the Patient

As discussed above, the pathophysiology of COPD involves the interaction of both cardiovascular and cardiopulmonary processes. Impairments in the cardiopulmonary functioning leading to COPD are associated with several risk factors including smoking, exposure to chemicals, race, age, and history of asthma (Hikichi et al., 2018). Such risk factors contribute to pathologic changes in the small (peripheral) bronchioles, large (central) airways, and lung parenchyma. Structural changes of the airways include ciliary abnormalities, focal squamous metaplasia, atrophy, inflammation, airway smooth muscle hyperplasia, and bronchial wall thickening leading to chronic bronchitis (Santus et al., 2019). Permanent enlargement of the airspaces from the distal to the terminal bronchioles also leads to a significant decline in the surface area of the alveoli available for gas exchange causing emphysema. The above mechanisms contribute to the patient’s symptoms such as shortness of breath, chronic cough, increased sputum production, and fever.

Conclusion

The middle-aged patient in the provided case study presents with symptoms indicating COPD exacerbation. Several cardiopulmonary processes contribute to the development of the patient’s condition such as the small (peripheral) bronchioles, large (central) airways, and the lung parenchyma. However, with a comprehensive understanding of the pathophysiology of the patient’s condition, it will be easier for the clinician to develop the most effective treatment plan.

 References

D’Cruz, R. F., Murphy, P. B., & Kaltsakas, G. (2020). Sleep-disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes. Journal of Thoracic Disease, 12(S2), S202–S216. https://doi.org/10.21037/jtd-cus-2020-006

Hikichi, M., Hashimoto, S., & Gon, Y. (2018). Asthma and COPD overlap the pathophysiology of ACO. Allergology International, 67(2), 179–186. https://doi.org/10.1016/j.alit.2018.01.001

Lee, H., Shin, S. H., Gu, S., Zhao, D., Kang, D., Joi, Y. R., Suh, G. Y., Pastor-Barriuso, R., Guallar, E., Cho, J., & Park, H. Y. (2018). Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease. BMC Medicine, 16(1). https://doi.org/10.1186/s12916-018-1159-7

Park, H. Y., Lee, H., Kang, D., Choi, H. S., Ryu, Y. H., Jung, K.-S., Sin, D. D., Cho, J., & Yoo, K. H. (2021). Understanding racial differences of COPD patients with an ecological model: two large cohort studies in the US and Korea. Therapeutic Advances in Chronic Disease, 12, 204062232098245. https://doi.org/10.1177/2040622320982455

Santus, P., Pecchiari, M., Tursi, F., Valenti, V., Saad, M., & Radovanovic, D. (2019). The Airways’ Mechanical Stress in Lung Disease: Implications for COPD Pathophysiology and Treatment Evaluation. Canadian Respiratory Journal. https://www.hindawi.com/journals/crj/2019/3546056/

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