Acute Coronary Syndrome: A Case Study of Thomas with Multiple Health Complications
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This case study discusses the pathophysiology related to the symptoms of Thomas, who is suffering from multiple health complications such as hypertension, hyperlipidaemia, and type 2 diabetes mellitus. It also covers the management of his conditions and the possible complications he may face.
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Acute Coronary Syndrome
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Table of Contents INTRODUCTION...........................................................................................................................1 MAIN BODY...................................................................................................................................1 CONCLUSION................................................................................................................................1 REFERENCES................................................................................................................................2
INTRODUCTION Acute coronary syndrome refers to sudden reduction of blood flow to heart due to blockage in arteries. It is usually caused by clot formation or plaque rupture in the arteries of heart. Patient may experience chest pressure while resting, dizziness, weakness, shortness of breathe and sudden heart stoppage. In this assessment, there is a case study of a patient who is suffering from a number of health complication such as hypertension, hyperlipidaemia and type 2 diabetes mellitus. In this project, pathophysiology related to the symptoms of Thomas has been discussed. Finally this project will going to discuss about the diabetes type two diabetes like diabetes mellitus and rheumatoid arthritis. MAIN BODY 1
2 Patient name: - Thomas Patient sex: - male Patient age: - 60 years’ old Complications: - Type 2 diabetes mellitus, rheumatic fever, hypertension and hyperlipidaemia. Type 2 diabetes mellitus Type 2 diabetes mellitus is known as insulin independent diabetes in which body resists the effects of insulin or does not secrete enough insulin for the process of metabolisms of sugar. Diabetes is a chronic condition which cannot be cure but patient can manage it with changing his lifestyle. Metformin is drug of choice in case of type 2 diabetes mellitus. Patient is diagnosed with diabetes before six years and he was taking metformin as antidiabetic drug. Fasting blood sugar test Normal blood sugar level= 100 mg/dL Elevated blood sugar level= 126 Mg/dL As Thomas has been prescribed metformin he may experience various symptoms such as weakness, sickness, tiredness, nausea, vomiting, stomach pain, rapid shortness of breath and dizziness. Thomas is already complaining increasing shortness of breath. Last night, he woke up at 2.00am and he sat on his recliner. He went to toilet and was feeling tiered by coming back on his recliner. Metformin may also cause contradiction such as impaired hepatic function, acute metabolic acidosis, renal dysfunction and hypersensitivity to metformin. For last 6 years, Thomas has been administering metformin and it caused vitamin B 12 deficiency. Shortage of vitamin B 12 always make him feel tired, faint and breathless. In this situation, he must take vitamin B12 supplements which would assist him to reduce all the side effects. Hyperlipidaemia It is a chronic condition where level of cholesterol get increased in the blood. Low density lipoprotein as called bad cholesterol whereas high density lipoproteins are called good cholesterol. HDL carries cholesterol back to the liver. LDL- Less than 160 mg/dL HDL – Greater than 60 mg/dL Triglycerides- greater than 200 mg/dL Sincemanyyears,hehas sufferedfromhyperlipidemia andthusadministering simvastatin.Simvastatinmay cause a number of side effects such as memory loss, itching, nausea,stomachpain, constipationandconfusion. Hypertension Hypertension is also known as elevated blood pressure where the pressure of blood gets increased against the wall of artery. Hypertension is caused due to long term kidney infections, unhealthy lifestyle choices, lack of physical activity and genetic characteristics. As Mr. Thomas was diagnosed with hypertension he has been administering enalapril which is an angiotensin converting enzyme inhibitor. Enalapril assist body to relax the blood Enalapril may cause shortness of breath, swelling in hand, face or mouth, itching, hoarseness, rash and difficulty in swallowing. Contradiction associated with enalapril may include collagen vascular disease, myocardial infraction, Other alternative medication for Thomas: - Lisinopril Ramipril Candesartan Irbesartan Valsartan Olmesartan other medications: - lovastatin, pravastatin, rosuvastatin, fluvastatin, atovstain Thomas blood pressure: - 189/103 SpO2 calculated: - 73% BP measurement test shows, he is a high blood pressure patient and requires the administration of antihypertensive drugs.
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In a given case study,Mr. Thomas complained for shortness of breath. Six years ago, he diagnosed with type 2 diabetes mellitus and has been administering metformin. Administering metformin for so long causes short of breath, weakness, dizziness, diarrhoea, loss of appetite, sickness and metallic taste in mouth Hahn and at. al., (2018). Due to this side effect he started feeling weak and tired and had difficulty on coming back to his recliner. Administration of metformin is associated with deficiency of vitamin B12. Prevalence of anaemia also becomes higher withthe longuseof metformin.Lower levelof vitaminB12 causesneuropathy prevalence. Thomas need to administer cobalamin supplementation to overcome with this deficiency. Deficiency of vitamin B12 made him feel faint, breathlessness tired and lack of energy. Due to lack of energy, he was not able to perform his daily activities. Vitamin deficiency may result to megaloblastic anaemia which is caused by the scarcity of vitamin B12 Tahhan and et. al., (2020).He also suffered from hypertension and blood pressure management was 189/103. In hypertension, kidney is both the target a contributing organ. Arterial blood pressure gets increased with the dysfunctionality of kidney. Important factors, play crucial role in pathogenesis of hypertension including rennin angiotensin aldosterone system, increased dietary salt intake, obesity and activation of neurohormonal system. Hypertension is a condition where the arterial pressure get increased. Increased salt intake enhances the ion concentration in the blood. Salt narrows the blood vessels and pressure of blood against the wall of artery get increased. Rennin angiotensin aldosterone system plays a critical role in regulation of blood pressure. Rennin angiotensin system refers to a group of related hormones which acts to regulate the blood pressure. Inappropriate functioning of RAAS system may cause high blood pressure. The oxygen level monitored was less than 95% and this can cause hypoxaemia Iliescu and at. al., (2018). In this case vasodilators are given as decreased tissue oxygen level due to reduced oxygen supply demands vasodilation Hahn and at. al., (2018).External oxygen supply may be alsopreferred.Hypoxaemiamayresultfromsleepapnoea,highaltitudeexposureand cardiopulmonary complications. As the sign and symptoms of Thomas reflects that he may be possible he may suffer with cardiac issues such as myocardial infarction and atherosclerosis. Thomas also complained about peripheral oedema as his ankles and feet were swelled. He was totally unable to walk and lie flat on bed. Thomas also experienced symptoms like chest pain and chest tightness which are indicators of myocardial infarction. Rupture of vulnerable plaque may 4
cause myocardial infarction. Myocardial infarction occurs if the muscles of heart are not getting enough oxygen. It is very dangerous condition caused by the lack of oxygen to the heart muscles. This occurs due to blockage in arteries. Fat get accumulated at the wall of the artery and arteries get narrowed result lack of oxygen and blood supply to the muscles. Thomas also diagnosed with hyperlipidaemia that means blood has too many lipids. Theses accumulated lipids are blocking his blood vessels and his blood pressure is geeing increased.Due to blockage he experienced shortness of breath Cavallari and at. al., (2018). Shortness of breathing and feeling tiredness are common symptoms of atherosclerosis. Atherosclerosis is a type of lipid accumulation in the vascular wall results to thickening and narrowing blood vessels, calcification, luminal stenosis. Hyperlipidaemiamayariselethalcomplicationssuchascardiovasculardisease,renal dysfunction,cerebralstrokesandhepaticdysfunction.Itmaybecausedduetogenetic abnormalities and it is quite possible that Thomas had also such family history. Thomas could improve his lifestyle in order to deal with it.Theses sign and symptoms indicates that Thomas is a heart patient and needs a heart surgery Nabovati and et. al., (2021). Thomas also diagnosed with type 2 diabetes mellitus. Type 2 diabetes mellitus is also known as insulin independent diabetes in which body shows resistance to the effects of insulin. Insulin is responsible for the metabolism of sugar, when body becomes resistance to insulin and thus sugar does not get metabolised leads to increased blood sugar level. Increased blood sugar level make Thomas feel tiered all the time. Thomas also noticed urinate a lot, usually a night which is a common symptom of high blood sugar level. Since childhood, Thomas develop rheumatic heart diseases which is caused by repeated attacks of rheumatic fever. This results to deformity and rigidity of valve cusps and shortening of chordae tedineae. Rheumatic fever alters the walls of heart, especially mitral wall get affected by rheumatic fever. Damage of heart walls may cause valve regurgitation, valve stenosis and also damage muscles of heart. As Thomas developed rheumatic heart disease he may suffer from heart failure. Rheumatic heart disease causes infection in heart valves and forms clot in the heart valves. Due to clot formation the oxygen supply gets decreased and Thomas starts feeling breathlessness. Due to rheumatic fever Thomas may also experience joint pain and skin redness. His feet and ankles also get swelled due to rheumatic fever Candelaria and et. al., (2020). Shortness of breath may also cause by lungs infection results pneumonia. In pneumonia pathogen reaches to the alveoli and damage thewall of alveoli. Damaged alveoli cause lack of oxygen and make Thomas feel breathless. According to the case 5
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report of Thomas, It is founded that he was also suffering from the exertion al anginaand also had four bypass surgery in the past years. As the symptoms of Thomas indicated, there may be the possibility of Exertion of Angina. The cause of angina is the outcomes of an imbalance between the myocardial oxygen demand and myocardial oxygen supply. Pathophysiology of angina: angina is due to the decreased blood flow for the heart muscle. Blood carries the oxygen molecule by the help of red blood cell through which the heart muscle needs to survive. At the time of heart muscle is not getting too much oxygen, as it cause a situation like ischaemia in which less supply of oxygen molecule reaches to heart muscle. The very common reason of the decreased in the blood flow for the heart muscle is CAD that coronary artery diseases Campo and et. al., (2020). The heart coronary arteries diseases can become too narrowed through the fat depositions known as plaques. This is also known as atherosclerosis. If this plaque in the blood vessel cause rapture or damages to the blood vessels or formation of blood clots, which can be fast block and decrease the flow via a narrowed artery. This severely and suddenly lower the flow of blood to the heart muscle and cause low oxygen level to the muscle.As the symptoms show in case of Thomas, like shortness of breathing, it may be due to the angina. It is most probable reason of shortness of breathing in the case of Thomas because in past year he took 4 by pass surgery Bainey and et. al., (2018). CONCLUSION From the above case study, it has been concluded that Mr. Thomas was diagnosed with a number of complications such as rheumatic heart disease, hypertension and type 2 diabetes mellitus. It has been analysed that administering a lot of medicines made him suffer with so many side effects. For example, Thomas has been prescribed metformin as he was diabetic patient. Use of metformin for so long made him feel tired and breathless. The patient was given alternativemedicinesinordertoovercomewithsideeffectsanddealwithhisheart complications. 6
REFERENCES Books and Journals Bainey and et. al., (2018). Population-level incidence and outcomes of myocardial infarction withnon-obstructivecoronaryarteries(MINOCA):InsightsfromtheAlberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study.International journal of cardiology,264, 12-17. Campo and et. al., (2020). The assessment of scales of frailty and physical performance improves predictionofmajoradversecardiaceventsinolderadultswithacutecoronary syndrome.The Journals of Gerontology: Series A,75(6), 1113-1119. Candelariaandet.al.,(2020).Health-relatedqualityoflifeandexercise-basedcardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis.Quality of Life Research,29(3), 579-592. Cavallari and at. al., (2018). Metabolic syndrome and the risk of adverse cardiovascular events after an acute coronary syndrome.European journal of preventive cardiology,25(8), 830- 838. De Vita, A and et. al., (2019). Coronary microvascular dysfunction in patients with acute Hahn and at. al., (2018)coronary syndrome and no obstructive coronary artery disease.Clinical Research in Cardiology,108(12), 1364-1370. Dong and et. al., (2018). Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-Iliescu and at. al., (2018)analysis.Clinical biochemistry,52, 131-136. Hahn and at. al., (2018). 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART- DATE): a randomised, open-label, non-inferiority trial.The Lancet,391(10127), 1274- 1284. Iliescu and at. al., (2018). Safety of diagnostic and therapeutic cardiac catheterization in cancer patients with acute coronary syndrome and chronic thrombocytopenia.The American Journal of Cardiology,122(9), 1465-1470. Langabeer and et. al., (2019). Gender-based outcome differences for emergency department presentation ofnon-STEMI acute coronary syndrome.The American Journal of Emergency Medicine,37(2), 179-182. Muskiet and et. al., (2018). Lixisenatide and renal outcomes in patients with type 2 diabetes and acute coronary syndrome: an exploratory analysis of the ELIXA randomised, placebo- controlled trial.The lancet Diabetes & endocrinology,6(11), 859-869. Nabovati and et. al., (2021). A global overview of acute coronary syndrome registries: a systematic review.Current Problems in Cardiology, 101049. Raposeiras-Roubín and et. al., (2018). Development and external validation of a post-discharge bleedingriskscoreinpatientswithacutecoronarysyndrome:TheBleeMACS score.International journal of cardiology,254, 10-15. Schnorbus and at. al., (2020). Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndromeundergoingcoronaryarterystenting:arandomized,blinded,parallel study.European Heart Journal,41(33), 3144-3152. 7
Shuvy and et. al (2018). Accuracy of the global registry of acute coronary events (GRACE) risk score in contemporary treatment of patients with acute coronary syndrome.Canadian Journal of Cardiology,34(12), 1613-1617. Tahhan and et. al., (2020). Enrollment of older patients, women, and racial/ethnic minority groupsincontemporaryacutecoronarysyndromeclinicaltrials:asystematic review.JAMA cardiology,5(6), 714-722. 8
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