The Significance of Risk Factors Associated with Heart and Lung Disease

The Significance of Risk Factors Associated with Heart and Lung Disease

Introduction

Heart and lung disease are two leading causes of death in the United States (CDC, 2019).  As many respiratory and cardiovascular disorders stem from lifestyle choices i.e. smoking, high fat diet, or a sedentary lifestyle, they are fortunately preventable.  The case study under examination illustrates the dire consequences for those whose who refuse to embrace a healthy lifestyle.

Signs and symptoms present in patient

Mrs. Paula Johnson came into the emergency room unconscious.  The day prior to Mrs. Johnson’s arrival, she was experiencing epigastric pain, nausea and found that her blood pressure was unusually high.  Unfortunately for Mrs. Johnson and her family she did not realize the significance of these symptoms until the following day. It is possible that she incorrectly associated her symptoms with a missed blood pressure medication dose or heart burn.    Upon Mrs. Johnson’s admission assessment, it was noted that she was diaphoretic, and her skin was cold and pale. She was tachypneic, tachycardic, hypotensive and had a thready pulse.  The situation did not look good.  If Mrs. Johnson had been educated on the possibility of a silent heart attack due to her condition of type II diabetes, perhaps this situation could have been prevented.

Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?

Several aspects of Mrs. Johnson’s personal and social history suggested she was at high risk for an MI.  She led a sedentary lifestyle and had smoked heavily for 45 years.  Her medical history of hypercholesterolemia, hypertension, and diabetes would also indicate that she may be obese.  These medical diagnoses, are all high-risk factors for coronary artery disease, thus increasing her risk of having an MI.  High cholesterol can cause plaque buildup within the coronary arteries increasing the risk of occluded circulation to the cardiac muscle.  Her smoking history adds to her risk of MI, because long term use of smoking leads to a buildup of scar tissue or atheroma, in the blood vessels and arteries, making them narrower and more susceptible to the formation of a thrombosis or blood clot, making blood flow to the heart ineffective.

What is a silent myocardial infarction, and why did it happen to this patient?

A silent myocardial infarction is a form of a heart attack that occurs with little to no symptoms.  Mrs. Johnsons diagnosis of diabetes type II is associated with a symptom known as neuropathy.  Type II diabetic’s most often experience neuropathy in their feet, but in some cases, neuropathy can be systemic and occur in other areas of the body including the heart.  Cardiac autonomic neuropathy is the form of neuropathy that occurs in the heart.  Unfortunately for Mrs. Johnson, this meant that when she was having a heart attack, she could not feel the true extent of her condition i.e. the chest pain commonly associated with MI’s.

What results do you expect to find in the tests ordered?

Mrs. Johnson had several labs test done to help diagnose her condition.  Her complete blood count came back with elevated levels of red blood cells, hemoglobin, and hematocrit (Mayo Clinic, 2019). Her white blood cell count and platelet count were also elevated (Mayo Clinic, 2019). Her cardiac enzymes came back with elevated levels of troponin I and T as well as elevated levels of creatine phosphokinase and kinase (Healthwise Staff, 2011). Her glucose levels came back elevated (National Institute of Health, 2017). The lipid panel showed elevated levels of triglycerides and LDL’S (American Association for Clinical Chemistry, 2019). Then they did an EKG and found that she had ST depression, T wave inversions, and abnormal Q waves (Vaz, 2019).  She also had a cardiac catheterization test done which showed decreased blood flow and oxygen to the heart, narrowed blood vessels, and possibly signs of necrotic heart tissue (Mayo Clinic, 2019).

What are some differential diagnoses?

Some differentia diagnoses based on Mrs. Johnsons symptoms of chest palpitations, profuse sweating, coldness of the skin and pallor, tachypnea, weak pulse, tachycardia, hypotension, and unconsciousness include, fainting, pulmonary embolism, diabetic ketoacidosis, and hypoglycemia (National Institute of Diabetes and Digestive and Kidney Disease, 2019).

What are some complications of myocardial infarction?

Myocardial infarction complications include sudden death in extreme cases, heart dysrhythmias, cardiogenic shock which is caused by decreased perfusion to the body’s vital organs, cardiac rupture, heart failure, angina pectoris (chest pain), thromboembolism (obstruction of blood vessel cause by clot), pericarditis (Inflamed pericardium), ventricular aneurysm, and Dressler’s syndrome (Pleuropericarditis) (Hubbard, 2003).

How do heart valvular disorders produce cardiac failure?

Heart valvular disorders occur when the valves of the heart become either stenotic (hardened and narrowed) in which they are unable to open properly, or the valves become incompetent (cannot close completely).  The stenotic and incompetent valves inhibit the valves ability to allow the blood to flow through the heart in the right direction.  The malfunctioning valves can than allow blood to back up into the heart chambers when it’s not supposed to.  This back flow of blood to the heart and the improperly functioning valves, puts a heavier workload on the heart forcing it to contract harder to get the blood through the valves than it’s supposed to.  If the stress on the heart to pump faster to keep blood and oxygen flowing to the extremities becomes to great, it can produce cardiac failure, as valve disease is high risk for heart failure.

What is endocarditis, and what are the most common causes?

Endocarditis is defined as an infection found within the endocardium of the heart.  It is caused by harmful streptococcal or staphylococcal bacteria attaching to irregular or damaged heart valves and/ or damaged tissue of the heart causing an infection to occur within the endocardium (Mayo Clinic, 2019).

How many types of shocks are there and what do they do?

There are 4 main types of shock, distributive, hypovolemic, cardiogenic, and obstructive.  Distributive shock causes peripheral vasodilation (Widening of the blood vessels) within the body.  Hypovolemic shock causes decreased intravascular volume (decreased blood in vessels) as well as increased systemic venous assistance, and decreased cardiac output resulting in hypotension.  Cardiogenic shock causes decreased cardiac output as well as systemic hypoperfusion (lack of oxygen and nutrients reaching tissues of body).  Obstructive shock causes decreased left ventricular cardiac output in the heart resulting in decreased blood flow in the body.

What is COPD?

COPD stands for chronic obstructive pulmonary disease.  COPD is often induced by patients that are life-long smokers due to the carcinogens and harmful substances they inhale into their lungs.  COPD causes thick respiratory secretions to accumulate in the lungs making it extraordinarily difficult for an individual to breath properly by obstructing air flow to and from the lungs. Symptoms of COPD include increased shortness of breath, thick mucus secretions, frequent coughing, increased breathlessness, wheezing, tightness, and difficulty breathing when lying down.

What are the three most common diseases that produce a COPD and their causes?

The three most common diseases that can produce a COPD are Emphysema, Chronic Bronchitis, and Refractory Asthma.   Emphysema occurs when the alveoli found within the lungs are damaged.  The walls found within the smaller alveoli are destroyed, resulting in the formation of large alveoli sacs within the lungs instead of the original small alveoli sacs.  These large sacs do not efficiently enable the process of gas exchange within the lungs like the small sacs did, which results in decreased oxygenation of the blood and tissues and the body as well decreased gas exchange within the lungs.  Chronic bronchitis is caused by a loss of the cilia found within bronchial tubes of the respiratory system.  The chronic swelling and irritation of the bronchial tubes is caused because the loss of the cilia within in the bronchial tubes, inhibits their ability to cough up mucous.  The increased coughing and mucus within the lungs, results in the irritation and swelling of the bronchial tubes which than causes severe dyspnea (difficulty breathing).  Refractory asthma or non-reversible is a form of asthma that can not be treated with ordinary asthma medications such as albuterol inhalers.  Asthma is caused by severe tightening and swelling of the bronchial airways, resulting in increased mucous and a narrowed airway, thereby inducing decreased gas exchange and oxygenation within the body.  Asthma can be triggered by environmental allergens, exercise and even the inhalation of harmful gases or fumes.  Symptoms of asthma include wheezing, shortness of breath, coughing, and chest tightness.

What is a pneumothorax and what are its symptoms, signs and causes?

A pneumothorax is defined as a collapse of the lung due to air escaping into the pleural space, causing increased pressure on the lung which causes it to collapse.  A penetrating chest injury and lung disease can cause a pneumothorax to occur in patients.  Signs and symptoms of a pneumothorax include sharp chest pain, pain when inhaling, cyanosis of the lips and skin, tachypnea (increased breathing), tachycardia (increased heart rate), and dyspnea (difficulty breathing).

Conclusion

Heart and lung disease are two of the leading causes of death in the United States.  In order to understand how these diseases, occur it’s important to know the risk factors that increase the risk of getting heart or lung disease.  Mrs. Johnson was at a high risk for having a myocardial infarction due in part to her sedentary lifestyle choices. Her medical history of smoking for 45 years, hypercholesterolemia diabetes type II all contributed to the development of atherosclerosis in her coronary arteries that led to her MI. This plaque buildup in her arteries contributed to the formation of a thrombosis that obstructed blood flow to her heart, resulting in her virtually symptomless heart attack. Mrs. Johnson’s MI was completely preventable.  If she began to put into place some necessary lifestyle changes i.e. stop smoking, consuming a healthy diet and exercising, she could prevent an incident like this from ever happening again.   Her history of being a heavy smoker for 45 years will also be a huge contributor to the possible diagnosis of COPD later in life. As a future health care professional, understanding heart diseases, the factors that contribute to a person’s susceptibility to them, and the numerous chronic respiratory diseases that can also occur from a majority of these risk factors will help in becoming a better nurse. Being qualified in understanding disease processes as well as what led up to the occurrence of these disease processes, is one of the most crucial parts of being a health care professional.

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