A Case Study about Cardiovascular Disease

Presented by: Kitt Barben A. Balaquit BSN-IV GROUP-4

Presented to: Mrs. Malou Argenos RN

PATIENTS PROFILE

Name: Age: Sex: Birth Date: Birth Place: Religion: Civil Status: Nationality: Address: Date of Admission: Chief Complaint: Admitting Diagnosis:

Cortez, Reynaldo 58 y/o Male June 24, 1953 San Luis, Batangas Roman Catholic Married Filipino Calumpang San Luis, Batangas August 01, 2011 5:00 pm Body Weakness of both upper and lower extremities Cardiovascular Disease

PAST HISTORY: Hypertension and Diabetes Mellitus

PRESENT HISTORY: Present condition persisted for hours PTA as slurring of speech with body weakness of both upper and lower extremities with nausea and vomiting.

Cardiovascular disease Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels (arteries and veins).While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions usually have similar causes, mechanisms, and treatments. Most countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer. In recent years, cardiovascular risk in women has been increasing and has killed more women than breast cancer. A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood. By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise, and avoidance of smoking. Population based studies show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 79 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease. This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken. Obesity and diabetes mellitus are often linked to cardiovascular disease, as are a history of chronic kidney disease and hypercholesterolaemia. In fact, cardiovascular disease is the most life threatening of the diabetic complications and diabetics are twoto four-fold more likely to die of cardiovascular-related causes than nondiabetics.

The Cardiovascular System consisting of heart and blood vessels, arteries, arterioles, capillaries, venules, veins, sinuses and lymphatics). The circulatory system transports respiratory gases, nutrients and waste products to various parts of the body. LOCATION Heart is a pumping organ of blood vascular system. It is located in the thorax between the lungs and abdomen behind the sternum and its apex rests on the diaphragm. STRUCTURE The structure of heart resembles the closed fist. It is hollow, muscular, contractile organ. The walls of heart possess three layers: 1. 2. The outer layer known as epicardium composed of serous The middle layer known as myocardium composed of cardiac muscle. layer

3. The inner layer known as endocardium which lines the four chambers of the heart and also covers the valves.

The heart is also enclosed in a fibrous sac called as pericardium. The space between pericardium and epicardium is known as pericardial cavity. This contains serous fluid that has lubricating action and thus helps in free movement of the heart. A septum divides the heart into right and left valves. These are further subdivided into four chambers viz. Right auricle, right ventricle, left auricle and left ventricle. The auricle (atria) is thin walled and serves as a receiving chamber for blood and are low pressure pumps. The ventricles are thick walled and serve as high pressure pump. The two atria open into the respective ventricles. These are guarded by an atrioventricular (AV) valve. Right AV valve is called as tricuspid valve (three cusps) whereas left AV valve is called as bicuspid valve (two cusps) or mitral valve. The atria and ventricle are completely separated from each other in order to prevent the mixing of impure (deoxygenated blood) and pure (oxygenated) blood. Superior and inferior vena cava brings deoxygenated blood from the upper and lower part of the body to the right atrium. This blood then enters the right ventricle through right AV valve. The AV valve allows the blood to flow from the atria to respective ventricles but prevents the back flow of blood. The walls of right ventricle are thinner than that of left ventricle. This is due to the fact that right ventricle has to pump deoxygenated blood to lungs only (which are very near) whereas, left ventricle has to pump oxygenated blood all over the body. The deoxygenated blood from right ventricle then goes to lungs for oxygenation through pulmonary artery. Pulmonary vein brings the oxygenated blood from the lungs to the left atrium. This pure blood is then forced from the left atrium to left ventricle through the left AV valve. The left ventricle opens in to aorta, which supply blood to all other tissues and organs. The opening of ventricles into these great arteries (pulmonary and aorta) is guarded by semilunar valves. These valves allow blood to enter the great artery from the ventricle but prevent its back flow.

SYSTEMIC CIRCULATION Systemic circulation is the flow of blood from the left ventricle through the aorta to all parts of the body (except lungs) and back to the right atrium. The functions of systemic circulation are to supply oxygen and nutrients to body tissues and to remove carbon dioxide, heat and other waste material from the tissue. All systemic arteries branch from the aorta, which arises from the left ventricle of the heart. PULMONARY CIRCULATION The flow of blood (impure) from the right ventricle of the heart to the lungs for purification and return of the pure blood from the lungs to the left atrium is called as pulmonary circulation. It is short circulation. The pulmonary trunk arises from the left ventricle and divides into four pulmonary arteries which carries blood in lungs (It is only this part of circulation where an artery carries deoxygenated blood). Pulmonary veins bring back the oxygenated blood from the lungs to the left atrium. (It is only this part of circulation where a vein carries oxygenated blood). The cardiovascular system can be thought of as the transport system of the body. This system has three main components: the heart, the blood vessel and the blood itself. The heart is the system's pump and the blood vessels are like the delivery routes. Blood can be thought of as a fluid which contains the oxygen and nutrients the body needs and carries the wastes which need to be removed. The following information describes the structure and function of the heart and the cardiovascular system as a whole. Structure and Function of the Heart

Function and Location of the Heart The heart's job is to pump blood around the body. The heart is located in between the two lungs. It lies left of the middle of the chest.

Structure of the Heart The heart is a muscle about the size of a fist, and is roughly cone-shaped. It is about 12cm long, 9cm across the broadest point and about 6cm thick. The pericardium is a fibrous covering which wraps around the whole heart. It holds the heart in place but allows it to move as it beats. The wall of the heart itself is made up of a special type of muscle called cardiac muscle. Chambers of the Heart The heart has two sides, the right side and the left side. The heart has four chambers. The left and right side each have two chambers, a top chamber and a bottom chamber. The two top chambers are known as the left and right atria (singular: atrium). The atria receive blood from different sources. The left atrium receives blood from the lungs and the right atrium receives blood from the rest of the body. The bottom two chambers are known as the left and right ventricles. The ventricles pump blood out to different parts of the body. The right ventricle pumps blood to the lungs while the left ventricle pumps out blood to the rest of the body. The ventricles have much thicker walls than the atria which allows them to perform more work by pumping out blood to the whole body. Blood Vessels Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are also microscopic blood vessels which connect arteries and veins together called capillaries. There are a few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC) or thesuperior vena cava (SVC). These two large veins then take the blood from the rest of the body into the right atrium. Valves Valves are fibrous flaps of tissue found between the heart chambers and in the blood vessels. They are rather like gates which prevent blood from flowing in the wrong direction. They are found in a number of places. Valves between the atria and ventricles are known as the right and left atrioventricular valves, otherwise known as the tricuspid and mitral valves respectively. Valves between the ventricles and the great arteries are known as the semilunar valves. Theaortic valve is found at the base of the aorta, while the pulmonary valve is found the base of the pulmonary trunk. There are also many valves found in veins throughout the body. However, there are no valves found in any of the other arteries besides the aorta and pulmonary trunk. What is the Cardiovascular System The cardiovascular system refers to the heart, blood vessels and the blood. Blood contains oxygen and other nutrients which your body needs to survive. The body takes these essential nutrients from the blood. At the same time, the body dumps waste products like carbon dioxide, back into the blood, so they can be removed. The main function of the cardiovascular system is therefore to maintain blood flow to all parts of

the body, to allow it to survive. Veins deliver used blood from the body back to the heart. Blood in the veins is low in oxygen (as it has been taken out by the body) and high in carbon dioxide (as the body has unloaded it back into the blood). All the veins drain into the superior and inferior vena cava which then drain into the right atrium. The right atrium pumps blood into the right ventricle. Then the right ventricle pumps blood to the pulmonary trunk, through the pulmonary arteries and into the lungs. In the lungs the blood picks up oxygen that we breathe in and gets rid of carbon dioxide, which we breathe out. The blood is becomes rich in oxygen which the body can use. From the lungs, blood drains into the left atrium and is then pumped into the left ventricle. The left ventricle then pumps this oxygen-rich blood out into the aorta which then distributes it to the rest of the body through other arteries. The main arteries which branch off the aorta and take blood to specific parts of the body are: Carotid arteries, which take blood to the neck and head Coronary arteries, which provide blood supply to the heart itself Hepatic artery, which takes blood to the liver with branches going to the stomach Mesenteric artery, which takes blood to the intestines Renal arteries, which takes blood to the kidneys Femoral arteries, which take blood to the legs

Treatment People with stable angina are usually treated by tight control of cardiovascular risk factors and by prescribing drugs (eg aspirin, beta-blockers, nitrates and long-acting calcium channel blockers). When unstable angina develops, the risk of heart attack is very high and rapid preventive treatment in an intensive or coronary care unit may be required. People with diabetes who have experienced an acute heart attack benefit to the same degree, and in some cases even more, from therapeutic interventions that are used in people without diabetes. Intensive insulin therapy for tight blood glucose control when the patient is in hospital has also proven to decrease death rates, and may be beneficial for at least three months following hospitalization. The DIGAMI Study from Sweden stresses the importance of controlling blood glucose levels during the acute phase and demonstrates that intensive insulin treatment also improves survival over the longer term, with a 24% reduction in death rates after three and a half years. This means a saving of one life for every nine patients on intensive insulin treatment. If people with diabetes require revascularization - a procedure to either open up blocked blood vessels (angioplasty) or to bypass them using implanted vessels from other parts of the body (bypass surgery) - bypass has proven to be a judicious choice particularly when several coronary vessels are involved, which is frequently the case in diabetes. The use of tiny metal devices called stents to keep arteries open has also improved the prognosis of some patients with diabetes and coronary heart disease.

Heart failure is a complication of coronary heart disease which occurs more frequently in people with diabetes. It is usually treated with drugs such as 'water tablets' (diuretics), ACE inhibitors, beta-blockers and digitalis Treatment of Cerebrovascular Disease As well as being a risk factor for stroke, diabetes and other high blood glucose conditions have adverse effects on both the short and long-term prognosis for stroke victims. Hyperglycaemia in the acute phase of stroke has been associated with high death rates, regardless of the presence or absence of diabetes. Tight glucose control improves the time of recovery. The standard therapies of intervention in stroke in people without diabetes are also helpful in people with diabetes. Indeed, the effect of aspirin on cardiovascular events in people with diabetes has been suggested to be even stronger than in people without diabetes. Resources need to be made available for the rehabilitation of stroke patients, which may be particularly complicated in people with diabetes due to the presence of other complications.

URINALYSIS Characteristics Normal Values Color Pale yellow to deep amber Result Dark Yellow Indication Any changes in urine color, or the presence of an abnormal urine color that cannot be linked to the consumption of a food or drug. Analysis Dilute urine may appear almost clear, or very pale yellow.

Reaction

4.5-8pH

6.0

A pH value Based on the greater than 7 result, it is considered to indicates be basic normal ph A pH value less because than 7 is acidic normally, urine is acidic Concentrated urine has a higher specific gravity; diluted urine has a lower specific gravity. Slightly increased implies nephritic syndrome

Specific gravity

1.010-1.025

1.030

RBC

Normal values are 4 red blood cells per high power field (RBC/HPF)

0-2

Greater than normal numbers of red blood cells in the urine may indicate: y Acute tubular necrosis y Cystitis y Glomerulo nephritis Interstitial nephritis The presence of pus cells always indicates infection.

Theres no RBC presence in the urine

Pus cells

35-40

The laboratory result shows presence of pus in the urine which indicates infection. Presence of amorphous urates in urine specimen proves little clinical value.

Amorphous Urates- it is seen as yellow to brown aggregates of small rounded particles

few

few

Common crystals seen even in healthy patients include calcium oxalate, triple phosphate crystals and amorphous phosphates. No sugar

Sugar

(-)

There is no presence of sugar in the urine.

DIAGNOSTIC PROCEDURE

Electrocardiography Electrocardiography is the most commonly used test for evaluating cardiac status, graphically records the electrical current (electrical potential) generated by the heart. This current radiates from the heart in all directions and, on reaching the skin, is measured by electrodes connected to an amplier and strip chart recorder. The standard resting ECG uses five electrodes to measure the electrical potential from 12 different

leads; the standard limb leads (I,II,III), the augmented limb leads (aVf, aVL, and aVr), and the precordial, or chest, leads (V1 through V6). Purpose of Electrocardiography (ECG)
y

y y y y

To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac hypertrophy, pericarditis, electrolyte imbalances, myocardial ischemia, and the site and extent of myocardial infarction. To monitor recovery from an MI. To evaluate the effectiveness of cardiac medication. To assess pacemaker performance To determine effectiveness of thrombolytic therapy and the resolution of STsegment depression or elevation and T-wave changes