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Cardiology Clinical Case

Cardiology Clinical Case

Case Study Evaluation

This case is about a cardiology patient, a 52-year old Irish male who had been hospitalized for four days following angina symptoms. The patient seems to have had a recurrent case because six months ago, similar symptoms had occurred. The case study is used as a guide for addressing the elements such as pathophysiology, symptoms/signs, progression of the disorder, diagnostic testing, as well as treatment options available.

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Pathophysiology

Cardiology cases are often characterized by atherosclerosis considered to be multifocal and characterized by immune-inflammation of medium and large arteries occasioned by lipids. The cells that play major role in the development of the disease include endothelial cells, smooth muscle cells, and leukocytes. There are many cardiovascular risk factors; however, the elevation of plasma cholesterol can sufficiently drive the development of atherosclerosis. The other risk factors include diabetes, male gender, hypertension, smoking, and inflammatory markers.

In endothelial cells, atherosclerotic lesions start to appear when intact, but leaky dysfunctional epithelium is activated. Endothelial cells may later disappear as denuded areas begin to appear with platelets adhering to exposed sub-tissues. Depending on the concentration and the size of the lesion, lipoprotein particles and plasma molecules may start to pass through the defectively leaky epithelium and into the sub-endothelial space where the atherogenic lipoproteins are modified and retained to be translated to cytotoxic. Endothelial dysfunction points to clinical events resulting from atherosclerosis.

Cardiovascular diseases occur because of atherosclerosis that involves medium and large sized arteries including renal arteries, visceral arteries, and arteries found on lower and upper extremities. The risk factors associated with the conditions include dyslipidemias, diabetes-mellitus, hypertension, smoking, metabolic syndrome, obesity, and ageing. There are also other factors such as atherogenic diet, family history of coronary artery disease, physical inactivity, as well as male gender (Zafar, 2015). The patient presented in a male meaning that is he is more predisposed for a cardiology case. 

Diabetes-mellitus as a risk factor is associated with medial calcification and atherosclerosis. Pathophysiology involves abnormalities that occur in platelet and endothelial smooth muscle cells function. Hyperglycemia, insulin resistance, metabolic abnormalities as well as more of the free fatty acids support mechanisms for vascular dysfunction. The abnormalities lead to cellular events that end up causing cardiovascular diseases and atherosclerosis.

Aging has become a critical risk factor in cardiovascular disease. Indeed, the patient in the case being a 52-year old is aging. Usually, endothelial dysfunction increases with age. Insufficiency in nitric acid, oxidative stress and inflammation are mediated by endothelial dysfunction associated with aging. Behaviors associated with healthy life styles help to maintain endothelial functioning as people get older thereby preventing the mechanisms (Zafar, 2015).

Metabolic syndrome is associated with increased number of free radicals and low anti-oxidant capacity recorded in obese patients. The imbalance witnessed in oxidative and anti-oxidative state as well as subclinical inflammation enhances the risk for diabetic complications and atherosclerosis (Zafar, 2015). 

Progression Trajectory

Disease progression can be understood from the persistence of this kind of cellular response. Intima monocytes can differentiate to form macrophages before internalizing atherogenic lipoproteins through scavenger receptors. If the macrophages become loaded with lipids with large amounts of cholesterol foam cells then that will form the promise of atherosclerotic lesions. As the supply of the lipoproteins continues, the macrophages also continue to eat up to the time they die.  On the other hand, scavenger and native LDL receptors are not regulated down by accumulation of cholesterol in the cells. When macrophages die because of necrosis and apoptosis, lipid core becomes destabilize inside the plaque. Under appropriate conditions, for instance, in the presence of high HDL and low LDL, macrophages can shrink by effusing cellular cholesterol to cellular HDL through a membrane transporter (Zafar, 2015). 

Signs and Symptoms

The symptoms that the patient had presented included crushing chest pain and shortness of breath. He had angina symptoms, substernal pain that was crushing and radiated to the neck. Besides, the patent reported that he had suffered from a heart attack previously but was afraid to seek medical attention.

Diagnostic Testing

To diagnostic tests belong electrocardiogram which can help the doctor to detect irregularities in the patient’s heart structure and rhythm. Similarly, echocardiogram as a noninvasive test including chest ultrasound can give the detailed structure of the patient’s heart and function. A third diagnostic test that would be applicable is the cardiac computerized tomography scan to collect the images of the patient’s chest and heart. Finally, cardiac magnetic resonance imaging is helpful in diagnosis.

Treatment options

The treatment options include Tenormin XL 50mg, Glucophage, and daily Lipitor.

Physical and Psychological Demands of the Disorder

Cardiology cases are often associated with depression. Notably, depression causes morbidity and mortality problems in patients with coronary heart disease, particularly in the case of coronary syndrome. Depression can lead to cardiovascular events as well as readmissions of patients causing further psychological tortures (Khyyam-Nekouei et al., 2013). It has also been shown that anxiety among patients suffering from cardiovascular disease can adversely affect prognosis. Myocardial infarction as well as cardiac death has been shown to have some level of anxiety in cardiac patients.

Social isolation as well as the lack of social support have been shown to be predictors of coronary heart disease, particularly in males (Khyyam-Nekouei et al., 2013). The patient in the case is isolated and does not have any relatives apart from his wife. Besides, he does not socialize with the neighbors for moral and social support. Loneliness, for instance, is an important risk factor in patients with heart failure. The more a patient feels lonely, the more the heart failure becomes severe.

If the patient used to be the main income source for the family, and he cannot work any longer because of his ill health, then the family may have to suffer or readjust to a new life style. In this case, the patient is reported to have been the sole bread winner. There are some necessities in life that the family may have to forgo because of reduced source of income. Similarly, the patient’s wife is disabled with type 2 diabetes while their children have left home and stay in a different city.

Regarding the physical demands, the man does not participate in any physical activities, which predisposes him more to the risk of cardiovascular disease.

The Key Concepts to Share with the Patient and Family

It is important to share with the patient information regarding frequent and continuous support on the need for appropriate diet as well as physical activity. The patient has not been following an appropriate dietary regime because he has skipped some meals or eaten fast food.

Concerning exercises, the patient needs to begin doing physical training and avoid the perception that he had done a lot of exercises when he was young and does not need it now.

In addition, the patient needs to be educated on the need of smoking cessation and offered support if necessary. Besides, the patient should know how health is affected by smoking, and how it may worsen his condition (Brown et al., 2011). 

The patient may need to know that he has a family history that predisposes him to the condition. His two brothers have been diagnosed with hypertension and type 2 diabetes. The two conditions have been associated with atherosclerosis which is common in patients with cardiovascular disease (Brown et al., 2011). Finally, it is important to let the patient know that if he continues to be anxious then his disease condition is bound to worsen. Therefore, it would be appropriate to limit depression or situations that cause anxiety (Brown et al., 2011).

Interdisciplinary Team Involved in the Care

The interdisciplinary team should include cardiologists, exercise physiologists, dieticians, general physicians, nurses, general practitioners, social workers, psychologist, pharmacists, and physiotherapists. The team will ensure that accurate diagnosis is made and treatment administered as per the existing guidelines. Notably, the cardiologist and nurses will ensure accurate diagnosis, treatment, and care. The nurse can also counsel the patient, his family as well as identify signs and symptoms. A general physician can help in the identification of etiological factors, diagnosis, as well as in implementation of evidence-based treatment. The physician can also arrange the future follow-up. The dietician is helpful in evaluating the patient’s dietary intake. He or she then recommends suitable diet that meets the patient’s needs. The dietician can offer dietary counseling to improve the body weight. Physical therapists are expected to advise the patients on reconditioning, training, and energy conservation. Pharmacists can check drug interactions, adverse effects of treatment, and advice on the choice of appropriate regimens and dosages. Psychologists and social workers are supposed to help the patient learn how to cope with his condition.

Barriers to Optimal Management and How to Overcome Them

Barriers to optimal management include financial constraints. The patient earns less and does not have a health insurance scheme. This has hindered him from getting specialized medical attention. Besides, the patient seems to lack education because he rarely goes to the hospital unless his condition worsens. He needs to know the importance of having regular check-ups. The patient also needs to be educated that he needs to go for regular checks regardless of how much money he earns annually. Similarly, the lack of social support can hinder disease management. Therefore, the patient should learn the need of socializing with the people in his community.  

Care Plan Synthesis

Comprehensive and Holistic Recognition and Planning for the Disorder

It is important to recognize the important role played by cholesterol as well as triglycerides in heart disease. Therefore, it will be necessary to choose a lipid test to determine the patient’s cholesterol levels as well as related proteins, and inflammatory factors. The latest scientific methods would be appropriate in this case, for example, imaging tests. The test should be able to determine change in distribution, texture as well as plaques in the patient’s blood. Advanced non-invasive tests should be used to get a conclusive diagnosis. The tests include cardiac CT scan, MRI, calcium scoring, echocardiogram, nuclear imaging, and stress testing will be very vital.

The cardiac rehabilitation chosen for the patient should enable him to recover after surgery or attack, prevent future problems, and address risks to heart problems. It should also help the patient to adopt a healthy life style such as eating foods that are good for the heart, being physically active, and knowing how to manage his stress.

Aggressive treatment for hypertension and hyperlipidemia should be considered. This can be achieved by targeting an appropriate blood pressure and cholesterol levels.  Medications are important in this case, for instance, cholesterol medications, blood pressure lowering medications, and medications for atherosclerosis may be applied.

Impact of Cultural Background on Optimal Management

One of the factors affecting the patient’s socio-cultural background and management outcome is financial history. The patient does not earn enough to meet the requirements of his medical care. Therefore, even if specialized treatment or medication is prescribed, he may not afford. Similarly, the patient lives in a community where he is not getting social support. He may require the help of his community members but if he does not interact with them, he may not easily get help. Thirdly, his children are staying away while the wife is disabled; therefore, he may not get immediate help should there be an emergency that requires the support of other people.

Evidence-based Approach

Medications should be tailored towards reducing hypertension. Besides, care givers will be helpful in providing counseling and guidance on managing anxiety. The involvement of cardiologist in the case will help in identifying the exact cardiac case that the patient is suffering.

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