Coronary Heart Disease
Section 1: Scenario
Mrs. S is a 68-year-old African-American female with a medical history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). She is married and has three children. Despite requiring a nasal oxygen cannula when doing physical activities due to her COPD, she still smokes four packets of cigarettes daily. She has smoked for the last 48 years. She experienced flu-like symptoms like nausea, malaise, fever, and productive cough three days ago. He could not do any activities of daily living and required help to walk up the staircases. She is currently on nimodipine and hydrochlorothiazide for her hypertension. The patient was admitted to the intensive care unit for acute COPD exacerbation and acute decompensated heart failure.
The patient was anxious during the interview, stating that she would die soon. She says that she always cries due to her pain. She feels like her heart is “running away” and complains that she is exhausted and cannot conduct activities of daily living without help. She also felt chest tightness. She feels she is a burden to others.
Vital signs: Ht 175cm Wt 94 kg BMI: 30.7 T 38.7 HR 120 RR 36 BP 95/60
Cardiovascular: S1, S2 heard distantly. PMI below the sixth ICS and faint. Bilateral jugular vein distention. Peripheral oedema.
Respiratory: Pulmonary crackles heard. Blood spilled sputum. SPO2 81%.
Gastrointestinal: Normoactive bowel sounds present. Hepatomegaly on palpation.
Section II: Patient Report
The diagnosis for this patient is coronary heart disease (CHD).
The patient has the risk factors for CHD. She is a post-menopausal woman, obese with a BMI of 30.7, has high blood pressure, and is a chronic smoker (Timmis et al., 2020). This increases her risk factor for getting CHD. The symptoms of CHD include chest aching, chest tightness, shortness of breath, and fatigue during exercise (Timmis et al., 2020). The patient complained of chest tightness and inability to walk up the stairs without help.
There are several risk factors for CHD. Some are modifiable, while others are not. The modifiable risk factors include high blood pressure, high cholesterol levels, smoking, obesity, diabetes, physical inactivity, stress and an unhealthy diet. The non-modifiable risk factors are advanced age, sex, family history and ethnicity.
It is one of the risk factors in CHD development. It increases the incidence of atherosclerotic CHD. The risk burden is increased 2-3 fold (Brown et al., 2020). CHD is the most common outcome of hypertension in all ages. Hypertension predisposes patients to all CHD clinical manifestations, such as angina pectoris, myocardial infarction, and sudden death (Brown et al., 2020). Even high regular blood pressure readings are linked with increased CHD risk (Brown et al., 2020). The presence of other CHD risk factors, such as obesity, hyperlipidemia, and diabetes, is observed in more people with prehypertension than those with regular BP readings (Brown et al., 2020). Prehypertension is thus a risk for CHD.
High cholesterol levels are a significant risk factor for CHD. There is a strong relationship between serum cholesterol levels and cardiovascular risk. Total serum cholesterol level is a valuable marker for predicting CHD. LDL-cholesterol is directly associated with CHD (Brown et al., 2020). Current guidelines note that LDL-C is the primary target for hypercholesterolemia therapy (Brown et al., 2020). HDL-C is an essential factor in atherosclerosis. Raising HDL-C is an important therapeutic strategy for reducing CHD incidence rates (Brown et al., 2020).
Smokers have an increased risk of myocardial infarction or sudden death linked to the number of cigarettes smoked daily (Brown et al., 2020). Cigarettes have harmful effects, with epidemiological statistics proving this to be true concerning CHD. Smoke cessation reduces nonfatal myocardial mortality (Brown et al., 2020). Patients with heart diseases should be advised on smoke cessation strategies. The risk of mortality linked with cigarette smoking falls after smoke cessation. Approximately 20% of patients who give up smoking after acute myocardial infarctions have a 40% reduction in infarct recurrences and mortality rates (Brown et al., 2020). The risk of developing CHD for smokers below 50 years is ten times greater than for nonsmokers in the same age bracket (Brown et al., 2020). Finally, passive smoking also enhances the risk of CHD (Brown et al., 2020).
Diabetes is a significant cardiovascular risk for CHD. Diabetes is associated with a 2-3-fold increase in the risk of atherosclerotic disease (Brown et al., 2020). A higher risk of CVD is higher in women with diabetes than their male counterparts (Brown et al., 2020). The American Heart Association (AHA) has several statistics that support diabetes as a risk factor for CHD. At least 68% of individuals aged 65 years or older with diabetes succumb to heart disease, while 16 % die of stroke (Brown et al., 2020). AHA also notes that diabetic adults are 2-4 times more likely to succumb to heart disease than non-diabetic individuals (Brown et al., 2020). The association considers diabetes one of the seven major modifiable risk factors for CHD. Even if glucose levels are under control due to antidiabetic medications, it still dramatically enhances the risk of stroke and heart disease since diabetic individuals also have comorbid conditions that are risk factors for CHD, such as smoking, obesity, physical inactivity, high cholesterol levels, metabolic syndrome and hypertension (Brown et al., 2020). Managing these risk factors may thus delay or prevent people with diabetes from developing CHD.
Many epidemiological studies have shown the relationship between physical activity and CHD. The relative risk of mortality from CHD in physically inactive individuals is 1.9 compared to active individuals (Brown et al., 2020). Physical exercises are a recommended preventive measure for individuals with CHD or at risk of developing CHD.
Obesity is an independent risk factor for all-cause death. Obesity is associated with comorbidities such as type 2 diabetes, CHD, sleep apnea, and hypertension (Brown et al., 2020). The metabolic profile changes and cardiac structure adaption occur due to excessive adipose tissue accumulation (Brown et al., 2020).
The additional questions I would ask the patient will include her family history of CHD. This will help me to determine whether her CHD has a genetic component. I would also inquire about the patient’s diet and lifestyle. I will ask about the patient’s medication adherence to see if it is the cause of the CHD. Finally, I will ask about the patient’s coping mechanisms and support systems since stress may be associated with risk for CHD.
In this case study, the patient has CHD due to the symptoms she presented with and the risk factors she has. The patient has comorbid medical conditions of hypertension and chronic heart failure. The patient is also a regular smoker. She also presented with a productive cough, fever, and malaise, which indicates a chest problem. This is due to the acute exacerbation of her COPD. In the past few days, the patient cannot perform activities of daily living due to shortness of breath and fatigue. Dyspnea and fatigue are symptoms of CHD due to cardiopulmonary congestion (Malakar et al., 2019). The patient gets tired quickly when performing duties. Patients with CHD can also experience dizziness, short-term headache, and nose bleeding (Malakar et al., 2019). The patient had fatigue and peripheral oedema. She has swellings on her ankles, feet and legs.
The patient is obese. She weighs 94 kg. Her BMI is 30.7. Obesity is a risk factor for CHD (Malakar et al., 2019). Physical examination reveals the patient has crackles, reduced breathing rate and SpO2 of 82%. She also has irregular heartbeats and a respiratory rate of 35. This shows that she has laboured breathing, a clinical manifestation of CHD (Malakar et al., 2019). A cardiac examination reveals atrial fibrillation and a ventricular rate of 132. The patient also has hepatomegaly. The clinical manifestations and risk factors strongly indicate that this patient has cardiovascular disease, specifically CHD.
There is no laboratory evaluation specifically for CHD. The laboratory workup ordered for this patient was to assess the risk factors for CHD. Blood tests were done to check for diabetes, dyslipidemia, chronic inflammation, and dyslipidemia (Kear, 2019). Her random blood sugar level was 5.8%, which indicated prediabetes. Her total cholesterol, LDL-C, and HDL-C levels were normal but in the upper range. Cardiac biomarkers were also tested. The sensitive indicators checked for were cardiac troponin I, creatine kinase- MB and cardiac troponin T (Kear, 2019). There were detectable levels of these cardiac markers in the blood, which indicated heart damage.
A few imaging studies were also ordered for this patient. A chest x-ray was called to view the size of the heart (Aggeli et al., 2018). The imaging results revealed that the patient had an enlarged heart due to cardiac hypertrophy. The second imaging test that was ordered was echocardiography. This test utilizes sound waves to create images of the heart. The photos reveal the shape and size of the heart and how well the heart valves work (Aggeli et al., 2018). The imaging results showed that the heart muscles were not contracting well.
The additional imaging test I recommend for this patient is a Doppler ultrasound. This test shows how blood flows through the valves and the chambers. It can detect blood clots, aorta problems and pericardial fluid buildup (Aggeli et al., 2018). The other test I would recommend for this patient is coronary CT angiography. This imaging test utilizes X-rays to produce pictures of the heart chambers in 3D and highlights coronary arteries (Aggeli et al., 2018). Magnetic resonance imaging (MRI) is also another essential diagnostic procedure. Cardiac MRI gives high-resolution images of the coronary arteries (Aggeli et al., 2018). It can use contrasting photos to show relative perfusion. The final procedure I would recommend is cardiac catheterization angiography. This is an invasive procedure that reveals blood flow in the coronary artery. During this procedure, a catheter will be inserted into a street in the arm or groin, and a dye will be injected into the coronary artery to locate stenotic segments (Bangalore et al., 2021). X-rays will guide the catheter to move up the heart. It will allow the visualization of narrow stenotic components. Angiography is used to evaluate the performance of heart valves and the left ventricles (Bangalore et al., 2021). However, it is an invasive procedure with risks and should only be done on patients who meet the criteria.
Aggeli, C., Mavrogeni, S., & Tousoulis, D. (2018). Non-invasive imaging techniques in coronary artery disease. Coronary Artery Disease, 337-358. https://doi.org/10.1016/b978-0-12-811908-2.00017-9
Bangalore, S., Barsness, G. W., Dangas, G. D., Kern, M. J., Rao, S. V., Shore-Lesserson, L., & Tamis-Holland, J. E. (2021). Evidence-based practices in the cardiac catheterization laboratory: A scientific statement from the American Heart Association. Circulation, 144(5). https://doi.org/10.1161/cir.0000000000000996
Brown, J. C., Brown, T. E., & Kwon, E. (2020, June 6). Risk factors for coronary artery disease – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK554410/
Kear, T. (2019). Clinical handbook for Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt.
Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review of coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology, 234(10), 16812-16823. https://doi.org/10.1002/jcp.28350
Timmis, A., Townsend, N., Gale, C. P., Torbica, A., Lettino, M., Petersen, S. E., Mossialos, E. A., Maggioni, A. P., Kazakiewicz, D., May, H. T., De Smedt, D., Flather, M., Zuhlke, L., Beltrame, J. F., Huculeci, R., Tavazzi, L., Hindricks, G., & Bax, J. (2020). European Society of Cardiology: Cardiovascular disease statistics 2019 (Executive summary). European Heart Journal – Quality of Care and Clinical Outcomes, 6(1), 7-9. https://doi.org/10.1093/ehjqcco/qcz065
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Comprehensive Case Study Report
This assignment addresses Course Outcomes:
**Use relevant vocabulary, including anatomical positions, to describe human anatomy and physiology and the role of homeostasis and metabolism in the normal functioning of organ systems.
**Apply knowledge of the chemical basis of life and biological processes to explain basic cell structure and function related to developing tissues and organs in anatomy and physiology.
**Use the scientific method to apply the principles of anatomy and physiology to form hypotheses and draw conclusions related to real-world problems about human systems.
**Using quantitative reasoning, analyze and interpret vital signs and other diagnostic measurements to make decisions about health status.
You are a student in a physician assistant program, and you must discuss with your professor and classmates in your daily meeting a case study report of one of the patients you have seen at the clinic. To prepare for your discussion, you should use the following format:
This assignment is broken into two sections. Neatly divide your case study into these two sections and bold your section HEADERS with the titles “Section 1: Scenario” and “Section 2: Patient Report.”
Scenario- Research and write a medical case study scenario between 200-300 words.
Patient report- Create a case study report with six content area subheadings. Make sure you answer all the questions comprehensively, demonstrating depth of knowledge. Use complete sentences and single-space your answers. This section should be at least 1500 words (not including references).
Your case study must be about a disorder involving one of the following:
Organs and organ systems
Autonomic nervous system
Cardiovascular and circulatory system
Example Case Study
Here is an example of “Section 1: Scenario”:
G. is a 45-year-old man with a 10-year history of type 2 diabetes. He has a blood pressure of 130/80 mmHg, treated with an angiotensin-converting enzyme inhibitor for the past two years. He has a stable background retinopathy and is a nonsmoker. His BMI has been 30 (height 5′10″, weight 210 lb) for the past year. He recently put himself on a high-protein diet to lose weight.
His weight has recently dropped by 10 lbs, his fasting serum triglyceride level has fallen from 185 to 130 mg/dl, and his blood pressure has decreased to 120/78 mmHg. His LDL cholesterol on a statin has remained stable at 102 mg/dl. His serum creatinine is 0.9 mg/dl, and his 24-hour urine shows a significant increase in microalbumuria from 100 mg/24 hours last year to 200 mg/24 hours.
Answering these questions for “Section 2: Patient Report” would be best. These should be listed as numbers with the headers I’ve written below and answered in depth.
1. Diagnosis Name
What is the name of the disease/disorder?
What are the reasons for your diagnosis?|
3. Causes/Risk Factors
What are some of the factors that put this patient at risk for the disease?
What other questions might you have for the patient that would provide you with more data?
4. Clinical Manifestation
Describe the clinical features of the disease that are present in the individual.
5. Diagnostic Procedures
What procedures were done on the patient, and what were the results?
Are there other diagnostic procedures that you would like to have performed? If so, which ones and why?
Report your references in APA format. You must use at least three primary peer-reviewed scientific sources over four years old. Websites like WebMD or Cancer Foundations do not count as references, but they may be good places for you to look for suggestions on essential papers that have been published. Please see the UMGC Writing and Citing Page if you need help with citations, writing and academic integrity: https://sites.umgc.edu/library/libhow/gethelp-citing.cfm
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