The cardiovascular and cardiopulmonary pathophysiologic processes
Case Study Scenario 6
Patients with diabetes often present with hypertension, a risk factor for other diabetic complications, including cardiovascular events. In this case study, the patient presents with chronic kidney disease and heart failure symptoms. Understanding the pulmonary and cardiovascular processes that lead to these conditions is crucial for practitioners in making diagnostic and treatment decisions. The purpose of this paper is to evaluate the pathophysiological processes related to pulmonary and cardiovascular processes presented in the case study.
The cardiovascular and cardiopulmonary pathophysiologic processes
Cardiac troponins are the sole biomarkers for determining the presence of acute myocardial infarction (AMI) (Stark et al., 2022). In people with chronic kidney disease, as presented in the case study, troponin elevation is related to cardiac injury rather than acute ischemia. The mechanism involved in the pathophysiological pathway starts with cardiac injury associated with heart failure or coronary heart disease (Wu, 2018). Injury causes blockage of blood flow through the coronary arteries, preventing oxygen supply to the heart muscles. Similarly, such damage can also occur in the pulmonary veins, causing a pulmonary embolism, which prevents the lungs from supplying the lungs to the heart. The patient cites edema, a clinical manifestation of pulmonary embolism (Chauin, 2021). When the blood supply to the heart is limited, a mismatch occurs between the available oxygen and the amount of oxygen required by the myocytes. Failure to meet the oxygen demand causes cell death and necrosis as the cell membranes rupture. The ra
ptured cells spill the intracellular contents into the extracellular space, which goes into the bloodstream (Pouru et al., 2020). Among the spilled substances are the troponins, which are measured to confirm an acute myocardial infarction. Hence, troponin elevation in the patient is due to the series of cardiac and pulmonary processes ignited by the injury of a cardiac muscle.
Racial/ethnic factors
Racial/ethnicity is a risk factor for cardiovascular conditions such as heart disease or heart failure. African-Americans, followed by Hispanics, are more vulnerable to heart failure than Whites. For instance, an African American with diabetes will be at high risk of developing heart disease or heart attack compared to a White patient with diabetes (Muncan, 2018). Hence, people from the African-American community are likely to experience worsening complications of diabetes-related to cardiovascular events.
How the processes affect the patient
The patient presents with several symptoms, including jaw pain that radiates to the neck, proteinuria, little voiding, high blood pressure, and non-fasting glucose of 410. These conditions point to uncontrolled blood sugar levels. High blood sugar levels and high blood pressure are risk factors and complications of each other, leading to processes that affect the patient. For example, a combination of high blood pressure and uncontrolled glucose levels in people with diabetes results in chronic kidney disease (CKD) (Vieira et al., 2029). Furthermore, uncontrolled hypertension worsens CKD, which might cause kidney failure. The effects of CKD manifest in edema, proteinuria, and elevated levels of non-fasting glucose. Similarly, hypertension is linked to cardiovascular events such as heart disease or heart failure. Hypertension causes damage to the arteries supplying blood to the brain, which either rapture or become blocked, interfering with blood flow. In severe cases, this causes heart failure, whose effects in the patient include high troponin levels and chest/jaw pain radiating to the back of the neck.
Conclusion
The patient presents with a complex case of diabetes, chronic kidney disease, and heart failure. The symptoms reported are due to these conditions. The pathophysiology that leads to the release of troponin starts with the hypertensive condition that causes cardiac injury, which initiates a series of events characterized by a reduced supply of oxygenated blood to the heart and other parts of the body, including the brain. Racial/ethnic origins affect physiological processes in people with diabetes because of susceptibility to cardiovascular events associated with African-Americans and Hispanics.
References
Chauin, A. (2021). The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis. Vascular Health and Risk Management, 17, https://doi.org/10.2147/VHRM.S327661.
Muncan, B. (2018). Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions. Public Health Rev, 39, 32. https://doi.org/10.1186/s40985-018-0109-4.
Pouru, J., Jaakkola, S., Biancari, F., Kiviniemi, T., Nuotio, I., & Airaksinen, K. (2020). Association of Heart Rate With Troponin Levels Among Patients With Symptomatic Atrial Fibrillation. JAMA Netw Open, 3(9):e2016880. doi:10.1001/jamanetworkopen.2020.16880.
Stark, M., Kerndt, C., & Sharma, S. (2022). Troponin. Treasure Island (FL): StatPearls Publishing.
Vieira, M. B., Neves, J., Leitão, L., & Baptista, R. (2029). Impaired Fasting Glucose and Chronic Kidney Disease, Albuminuria, or Worsening Kidney Function: A Secondary Analysis of SPRINT. The Journal of Clinical Endocrinology & Metabolism, 104(9), 4024–4032, https://doi.org/10.1210/jc.2019-00073.
Wu, A. H. (2018). Release of cardiac troponin from healthy and damaged myocardium. Frontiers in Laboratory Medicine, 1(3), 144-150. https://doi.org/10.1016/j.flm.2017.09.003.
| Excellent | Good | Fair | Poor | ||
| Main Posting | 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors. |
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style. |
|
| Main Post: Timeliness | 10 (10%) – 10 (10%)
Posts main post by day 3. |
0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
Does not post by day 3. |
|
| First Response | 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. |
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English. |
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. |
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. |
|
| Second Response | 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. |
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English. |
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. |
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. |
|
| Participation | 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. |
0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days. |
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| Total Points: 100 | |||||
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Important information on Writing a Discussion Question
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- Follow APA-7th edition
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Participation –replies to your classmates or instructor
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