Anatomy and physiology
Spending all day on their feet, especially for overweight people, renders them inactive and sedentary, and they have little muscle activity in their legs. This subsequently leads to the pooling of blood in the lower extremities, especially the legs, thus resulting in compromised venous return to the heart. This condition, in turn, reduces the cardiac output in such patients, and therefore, the oxygenated blood to the tissue becomes reduced throughout the body (Rossignol et al., 2019). This, therefore, explains the patients’ symptoms of shortness of breath, fatigue, and swelling of the feet, which commonly reflect reduced perfusion to the brain.
Initially, the decreased cardiac output stimulates baroreceptors, which in turn kindles the sympathetic nervous system (SNS). The stimulated SNS stimulates the production of both vascular and cardiac responses through the release of norepinephrine, which increases contractility and heart rates by exciting the beta-receptors. The released norepinephrine also causes arterial and venous vasoconstriction (Gabriel-Costa, 2018). To maintain perfusion in vital organs, blood flow to the heart and the brain is redistributed, thus decreasing renal perfusion, which in turn causes the release of renin by the kidney. Stimulation of the reduction of the aldosterone by the adrenal cortex and additional vasoconstriction and secretion of antidiuretic hormone is produced by activation of the renin-angiotensin-aldosterone system (RAAS). The secreted aldosterone stimulates the reabsorption of sodium in the renal tubules, which in turn promotes water retention.
These changes result in significant weight gain and an increase in the capillaries pressure, resulting in edema. The patient may also develop shortness of breath due to reabsorption of the edematous fluid into the circulation, thus causing pulmonary congestion and fluid overload, hence the commonly used term congestive cardiac failure. CHF is a cardiac function disorder that is frequently due to impaired contraction of the heart. Severe heart failure can result in shortness of breath at rest as well as with activity (Gabriel-Costa, 2018).
Gabriel-Costa, D. (2018). The pathophysiology of myocardial infaAdd Newrction-induced heart failure. Pathophysiology, 25(4), 277-284. https://www.sciencedirect.com/science/article/pii/S0928468017301724
Rossignol, P., Hernandez, A. F., Solomon, S. D., & Zannad, F. (2019). Heart failure drug treatment. The Lancet, 393(10175), 1034-1044. https://www.sciencedirect.com/science/article/pii/S0140673618318087
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An overweight patient comes to a clinic complaining of fatigue, swollen feet, and shortness of breath. She also admits that sometimes, she feels that she cannot think clearly. She works at a local retail store, and she is on her feet all day. When she isn’t working, she doesn’t do any exercise. With her weight, she finds it hard to walk too much. Explain the strain she is putting on her vasculature and respiratory system, and explain what may be involved in this patient’s signs and symptoms.
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