76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits

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Case Study Analysis

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Institution

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Case Study Analysis

Scenario: 76-year-old female patient complains of weight gain, shortness of breath, peripheral

edema, and abdominal swelling. She has a history of congestive heart failure and admits to not

taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.”

She now must sleep on two pillows in order to get enough air.

Introduction

The cardiovascular and cardiopulmonary systems are some of the most vital organs of the

human body. They include the lungs, arteries, veins, heart, and blood vessels. The two systems

work hand in hand to aid in the transportation of oxygen throughout the body. Congestive heart

failure is a common dysfunction of the cardiovascular and cardiopulmonary and it’s a common

condition in the United States (Enwerem et al., 2018). It is a condition characterized by heart

failure to pump enough oxygenated blood to the whole body. This may cause organ failure, fluid

collection in the lungs, swelling, and shortness of breath. In addition, congestive heart failure is

indicated by fatigue, dyspnea upon laying down, ascites, and edema. The presented patient case

exhibits the symptoms of congestive heart failure. This paper will explore both cardiovascular

and cardiopulmonary pathophysiologic processes of the presented patient symptoms, the

interaction of the cardiovascular and cardiopulmonary pathophysiologic processes, and

racial/ethnic variables which may affect physiological functioning.

The Cardiovascular and Cardiopulmonary Pathophysiologic Processes that Result in the

Patient Presenting these Symptoms

The patient exhibits symptoms of congestive heart failure exacerbation because of

diuretic non-adherence. The duration that she has experienced the symptoms and diagnostic tests

and values are useful. In addition, the patient is experiencing abdominal swelling, weight gain,

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peripheral edema, and shortness of breath which are the main clinical indications of right-sided

heart failure (Dharmarajan & Rich, 2017). Cardiovascular pathophysiologic processes may result

from behavioral practices such as poor dietary measures, which develop from the inability to

cope with distress, increased smoking, and reduced physical exercises. In addition, stress

activates the sympathetic nervous system and pituitary adrenocortical axis, which triggers

pathophysiological processes, including cardiac metabolic control, inflammation, and

homeostasis (Hohlfeld et al., 2018). Intrathoracic pressure is decreased by spontaneous reduction

of inspiratory efforts. The spontaneous efforts may result in acute ventricles failure leading to

pulmonary edema and cardiac failure.

Any Racial/Ethnic Variables that may Impact Physiological Functioning

Racial and ethnic variables which are likely to affect physiological functioning are body

fitness and eating habits. In addition, alcohol consumption and continuous smoking have an

adverse influence on older adults and may lead to an increased risk of heart failure and other

complicated conditions. According to Carnethon et al. (2017), African Americans live an average

unhealthy life compared to white people who live healthier lives.

How the Cardiovascular and Cardiopulmonary Pathophysiologic Processes Interact

to Affect the Patient

Cardiovascular and cardiopulmonary processes interact in the heart when the lungs

experience hyperinflation on the left side of the heart (Dharmarajan & Rich, 2017). Forward

heart failure may occur due to the inability of the heart to pump blood effectively from the lungs.

Forward heart failure is indicated by symptoms such as palpitations, fatigue, and weakness. On

the other hand, backward heart failure occurs when the heart cannot pump deoxygenated blood

from the body parts. This results in abdominal swelling, shortness of breath, and jugular vein

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distension. The heart failure to pump blood to the lungs from the body parts for oxygenation, the

fluid load increases in the body. The backed-up blood causes a high concentration of carbon

dioxide and results in fatigue and weakness. According to Hohlfeld et al. (2018), when the heart

fails and enlarges, it causes pressure to the lung, which may not expand fully, causing shortness

of breath.

Conclusion

Congestive heart failure causes several admissions in hospitals every year. The indicators

of congestive heart failure are weight gain, dyspnea, ascites, and edema. African Americans are

prone t the condition due to their socioeconomic and risk of obesity and hypertension. As

congestive heart failure develops, the heart enlarges and causes pressure on the lungs, which

stiffens, increasing the risk of adverse long-term organ damage.

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References

Carnethon, M. R., Pu, J., Howard, G., Albert, M. A., Anderson, C. A., Bertoni, A. G., … & Yancy,

C. W. (2017). Cardiovascular health in African Americans: a scientific statement from the

American Heart Association. Circulation, 136(21), e393-e423. https://doi-

org.ezp.waldenulibrary.org/10.1161/CIR.0000000000000534

Dharmarajan, K., & Rich, M. W. (2017). Epidemiology, pathophysiology, and prognosis of heart

failure in older adults. Heart failure clinics, 13(3), 417-426.

https://doi.org/10.1016/j.hfc.2017.02.001

Enwerem, N. M., Okunji, P. O., Ngwa, J. S., Karavatas, S. G., Fungwe, T. V., & Obisesan, T. O.

(2018). Prevalence of Parkinson Disease in Hospitalized Patients with Congestive Heart

Failure. International Journal of Studies in Nursing, 3(2), 23.

https://doi.org/10.20849/ijsn.v3i2.371

Hohlfeld, J. M., Vogel-Claussen, J., Biller, H., Berliner, D., Berschneider, K., Tillmann, H. C., …

& Welte, T. (2018). Effect of lung deflation with indacaterol plus glycopyrronium on

ventricular filling in patients with hyperinflation and COPD (CLAIM): a double-blind,

randomized, crossover, placebo-controlled, single-center trial. The Lancet Respiratory

Medicine, 6(5), 368-378. https://doi.org/10.1016/s2213-2600(18)30054-7

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1 ADVANCED PATHOPHYSIOLOGY

Students Name

Institutional Affiliation

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2 ADVANCED PATHOPHYSIOLOGY

Case Scenario

76-year-old female patient complains of weight gain, shortness of breath, peripheral

edema, and abdominal swelling. She has a history of congestive heart failure and admits

to not taking her diuretic, as it makes her “have to get up every couple hours to go to the

bathroom.” She now must sleep on two pillows in order to get enough air.

Introduction

Congestive heart failure is a chronic and progressive disease that influences the

ability of heart muscles to pump blood within the heart. Blood pumping becomes

ineffective after the buildup of fluid in the heart. This paper explores a congestive heart

failure patient, presenting both cardiovascular as well as cardiopulmonary

pathophysiologic processes leading to the patient's symptoms, the influence of ethnicity

and racial variables, and the interaction of processes affecting the patient on the above

scenario.

Cardiovascular and cardiopulmonary pathophysiologic processes

The patient in the above scenario presents with symptoms such as abdominal

swelling, weight gain, and peripheral edema history. Since the patient has a history of

cognitive heart failure, the above symptoms might be occurring due to cognitive heart

failure. It is important to understand that abdominal swelling and peripheral are caused

by heart failure (McCance, &Huether, 2019). Cognitive heart failure is the major

cardiovascular process that results in the patient presenting the above symptoms.

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3 ADVANCED PATHOPHYSIOLOGY

Cognitive heart failure makes the heart weak, thus failing to pump blood within the body.

This causes blooding clotting in front of the heart.

The patient admitted that she does not take diuretics since they made her get up

every few hours to go to the bathroom. "Diuretics are the mainstay pharmacological

therapy which reduces preload in patient with cognitive heart failure and their

medications inhibit water reabsorption from the tubules which consequently increases the

volume and loss of water in the urine" (Josep Comín-Colet et al., 2020). Due to the heart

damage, the patient presented symptoms of muscular heart efficiency. In systole

dysfunction, the stroke volume is reduced, thus making the heart muscle enhance end-

systolic volume. When there is a reduction in fibers myosin during the process of heart

relaxation as well as contractions, the heart's contractility is lost (Carter et al., 2019).

Racial/ethnic variables

African Americans have higher chances of being affected by heart failure

conditions compared to white Americans. Also, compared to ethnic groups, they register

more deaths due to cognitive heart failure (Tillman et al., 2019). It is estimated that

around fifty percent of African Americans are affected by cognitive heart failure, where

hypertension is considered is the major contributing factor (Josep Comín-Colet et al.,

2020). Sodium sensitivities, rennin activities (relatively low), as well as low nitric oxide

production are mostly found in the pathophysiology of hypertension in African

Americans. Some other conditions include limited care access, genetics, kidney diseases,

and reduced compliance to medications.

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4 ADVANCED PATHOPHYSIOLOGY

Processes interaction

When both functional and structural changes occur on the hearts of clients

diagnosed with cardiovascular heart failure, they interact, resulting in the rise of disease

conditions. The stroke volume occurs in a patient with cardiovascular heart failure due to

a compensatory increase in blood volume, which improves the ventricular preload.

"Aorta baroreceptors and stretch receptors are also stimulated by decreases in blood

pressure which the results in stimulation of the sympathetic nervous system" (Inamdar &

Inamdar, 2016). Cardiovascular and cardiopulmonary pathophysiologic processes cause

renal perfusions, which reduce, thus affecting output and retention of urine inpatient.

Reduction of blood flow in the kidney causes the release of renin as well as angiotensin.

Also, it leads to fluid and sodium retention, especially when the condition continues, thus

increasing blood volume circulation.

Conclusion

Cardiovascular heart failure influences the ability of blood pumping by heart

muscles, and it results in specific symptoms like in the above case. Diuretics play an

essential role in treating heart failure and high blood pressure conditions. However, a lack

of close observance can cause damages to the heart. In conclusion, African Americans are

most affected by heart failure, with high blood pressure being the leading cause. Due to

changes in the normal functioning of the heart, the conditions of disease increase.

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5 ADVANCED PATHOPHYSIOLOGY

References

Carter, P., Lagan, J., Fortune, C., Bhatt, D. L., Vestbo, J., Niven, R., Chaudhuri, N.,

Schelbert, E. B., Potluri, R., & Miller, C. A. (2019). Association of

Cardiovascular Disease With Respiratory. Disease. Journal of the American

College of Cardiology (JACC), 73(17), 2166–2177. https://doi-

org/10.1016/j.jacc.2018.11.063

Inamdar, A. A., & Inamdar, A. C. (2016). Heart failure: diagnosis, management and

utilization. Journal of clinical medicine, 5(7),

62 ; https://doi.org/10.3390/jcm5070062

Josep Comín-Colet, Teresa Martín Lorenzo, Almudena González-Domínguez, Juan

Oliva, & Silvia Jiménez Merino. (2020). Impact of non-cardiovascular comorbidities on

the quality of life of patients with chronic heart failure: a scoping review.

Health and Quality of Life Outcomes, 18(1), 1–13. https://doi-

org/10.1186/s12955-020-01566-y

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease

in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Tillman, F., Kim, J., Makhlouf, T., & Osae, L. (2019). A comprehensive review of

chronic heart failure pharmacotherapy treatment approaches in African

Americans. Therapeutic advances in cardiovascular disease, 13,

1753944719840192. https://doi.org/10.1177/1753944719840192

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