Case Study 8: Cardiovascular Disorder; a 63 y/o Hispanic woman with PMH of CAD -
Reports increasingly weak over the last couple of weeks and unable to do her housework c/o swelling of ankles and feet by late afternoon (she can’t wear shoes) and has nocturnal dieresis x4 daughter took her to MD because heaviness h eaviness of chest on and off over the last few days; denies discomfort VS: 146/92, 96, 37C IV D5W KVO at right forearm
Labs: Na 134 mmol/l, K 3.5 mmol/L, Cl 103 mmol/L, HCO3 23 BUN 13 mg/dl, Crea 1.3 mg/dl, WBC 8.3 thou/cmm, platelet 162 thou/cmm, Hct 33.9%, Hgb 11.7 g/L PT/ INR, PTT, and UA are pending Coronary artery disease Clinical Information
A disease in which there is a narrowing or b lockage of the coronary arteries (blood vessels that carry blood and oxygen ox ygen to the heart). Coronary artery disease is usually caused by atherosclerosis (a build up of fatty material and plaque inside the coronary arteries). The disease may cause chest pain, shortness of breath during exercise, and heart attacks. The risk of coronary artery disease is increased b y having a family history of coronary artery disease before age 50, older age, smoking tobacco, high blood bloo d pressure, high cholesterol, diabetes, lack of exercise, and obesity. A thickening and loss of elasticity of the walls of arteries that occurs with formation of atherosclerotic plaques within the arterial intima. Age, lifestyle, diet, and gene related degen eration of arteries due to deposition of lipoid plaques (atheromas) on inner arterial walls; main cause of coronary artery disease, a leading cause of death. An imbalance between myocardial functional requirements and the capacity of the coronary vessels to supply sufficient blood flow. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. That limits the flow of oxygen-rich blood to your body and can lead to serious problems, including coronary artery disease. These arteries supply blood to your heart. When they are o blocked, you can suffer angina or a heart attack. carotid artery disease. These arteries supply blood to your brain. When they are o blocked you can suffer a stroke. peripheral arterial disease. These arteries are in your arms, arms, legs and pelvis. When o they are blocked, you can c an suffer from numbness, pain and sometimes infections.
atherosclerosis usually doesn't cause symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency.a physical examination, imaging and other diagnostic tests can tell if you have it. Treatments include medicines, and medical procedures or su rgery. Lifestyle changes can also help. These include following a healthy diet, getting regular exercise, maintaining a healthy weight, quitting smoking, and managing stress.
Build-up of fatty material and calcium deposition in the arterial wall resulting in partial or complete occlusion of the arterial lumen. Coronary artery disease (cad) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.cad happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks h appen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage. Over time, cad can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood bloo d well to the rest of the bod y. Arrhythmias are changes in the normal beating rhythm of the heart. Deposition of cholesterol and lipid in the inner layer of the blood vessel Narrowing of the coronary arteries due to fatty deposits inside the arterial arterial walls. The diagnostic criteria may include documented history of an y of the following: documented coronary artery stenosis greater than or equal to 50% (b y cardiac catheterization or other modality of direct imaging of the coronary arteries); previous coronary artery b ypass surgery (cabg); previous percutaneous coronary intervention (pci); previous myocardial infarction. Thickening and loss of elasticity of the coronar y arteries, leading to progressive arterial insufficiency (coronary disease).
Applicable To
Atherosclerotic cardiovascular disease Coronary (artery) atheroma Coronary (artery) atherosclerosis Coronary (artery) disease Coronary (artery) sclerosis
Use Additional
code, if applicable, to identify: coronary atherosclerosis due to calcified coronary lesion (I25.84 coronary atherosclerosis due to lipid rich plaque (I25.83 )
Type 2 Excludes
)
atheroembolism (I75.- ) atherosclerosis of coronary artery bypass graft(s) and transplanted heart ( I25.7-
)
Mortality Data
Between 1999-2007 there were 1,880,822 deaths in the United States where ICD-10 I25.1 was indicated as the underlying cause of death [source: cdc.gov ]
Weakness Clinical Information
A sign or symptom of weakness and diminished or absent energy and strength. Clinical sign or symptom manifested as debility, or lack or loss of strength an d energy. Physical weakness, lack of strength and vitality, or a lack of concentration. The property of lacking physical or mental strength; liability to failure under pressure or stress or strain. (wordnet) Weakness; lack of energy and strength.
Applicable To
Asthenia NOS
Type 1 Excludes
age-related weakness (R54
muscle weakness (M62.8-
senile asthenia (R54
) )
)
Edema, unspecified Clinical Information
(eh-dee-ma) swelling caused by excess fluid in body tissues. Abnormal fluid accumulation in tissues or body cavities. Most cases of edema are present under the skin in subcutaneous tissue. Accumulation of an excessive amount of watery fluid in cells or intercellular tissues. Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles and legs, but it can involve your entire body. Causes of edema include eating too much salt o sunburn o heart failure o kidney disease o liver problems from cirrhosis o pregnancy o problems with lymph nodes, especially after mastectomy o some medicines o
o
standing or walking a lot when the weather is warm
to keep swelling down, your health care provider may recommend keeping your legs raised when sitting, wearing support stockings, limiting how much salt you eat o r taking a medicine called a diuretic - also called a water pill.
Pathological transudate within one or more tissues. Swelling from excessive accumulation of serous fluid in tissue.
Applicable To
Fluid retention NOS
Description Synonyms
Body fluid retention Edema Edema (swelling) Edema (swelling), arms and legs Edema of foot Pedal edema Pedal edema (foot swelling) Peripheral edema
Mortality Data
Between 1999-2007 there were 27 deaths in the United States where edema was indicated as the underlying cause of death [source: cdc.gov ]
Diuresis / other polyuria Clinical Information
Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes (diabetes mellitus; diabetes insipidus).
Applicable To
Polyuria NOS
Description Synonyms
Polyuria Polyuria (excessive urination)
ICD-10-CM R35.8 is grouped within Diagnostic Related Group(s) (MS-DRG v30.0):
695 Kidney & urinary tract signs & symptoms with mcc 696 Kidney & urinary tract signs & symptoms without mcc
Convert ICD-10-CM R35.8 to ICD-9-CM The following ICD-10-CM Index entries contain back-references to ICD-10-CM R35.8:
Discharge (from) excessive urine R35.8
Diuresis R35.8 Polyuria R35.8 Secretion urinary excessive R35.8
Urine discharge, excessive R35.8 secretion excessive R35.8
Basic Metabolic Panel Why Get Tested? To give your health care provider important information about the current status of your kidne ys as well as electrolyte and acid/base balance and level of blood glucose
When is it ordered? A BMP may be ordered as part of a routine health exam. The panel is also often ordered in the hospital emergency room setting because its components give doctors important information about the current status of a person's kidneys, electrolyte and acid/base balance, balance, and blood glucose and calcium levels. Significant changes in these test results can indicate acute acute problems, problems, such as kidney failure, insulin shock or diabetic coma, respiratory distress, or heart rhythm changes.
Creatinine
Why Get Tested? To determine if your kidneys are functioning normally and to monitor treatment for kidney disease
When to Get Tested? Routinely as part of a comprehensive or basic basic metabolic panel; panel; when your doctor suspects that you are suffering from kidney dysfunction or when you are acutely or chronically ill with a condition that may affect your kidneys and/or be worsened by by kidney dysfunction; at intervals to monitor treatment for kidney disease or kidne y function while on certain medications
Glucose Why Get Tested? To determine if your blood glucose level is within a healthy range; to screen s creen for, diagnose, and monitor high blood glucose (hyperglycemia hyperglycemia)) or low blood glucose (hypoglycemia hypoglycemia)), diabetes diabetes,, and pre-diabetes;; to check for glucose in your urine pre-diabetes
When to Get Tested? Blood glucose: glucose: as part of a regular ph ysical, when you have symptoms suggesting hyperglycemia or hypoglycemia, and during pregnancy during pregnancy;; if you are diabetic, self-checks up to several times a day to monitor blood glucose levels Urine glucose: glucose: usually as part of a urinalysis
Sample Required? A blood sample drawn from a vein in your arm or a drop of blood from a skin prick; sometimes a random urine sample is used. Some diabetic patients may ma y use a continuous glucose monitor, which is a small sensor wire inserted beneath the skin of the abdomen that measures blood glucose every five minutes.
Test Preparation Needed? In general, it is recommended that you fast - nothing to eat or drink except water - 8 hours hou rs before having a blood glucose test. In persons with diabetes, glucose levels are often che cked both while fasting and after meals to provide the best c ontrol of diabetes. For random, timed, and post-meal glucose tests, follow your doctor's instructions. instructions.
What does the test result mean? Blood Glucose
High levels of glucose most frequently indicate diabetes diabetes,, but many other diseases and conditions can also cause an elevated blood glucose. The following information summarizes the meaning of the test results. These are based on the clinical practice recommendations of the American Diabetes Association.
Fasting Blood Glucose Glucose Level
Indication
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)
Normal fasting glucose
From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
Impaired fasting glucose (prediabetes)
126 mg/dL (7.0 mmol/L) and above on more than one testing Diabetes occasion
White Blood Cell Count Why Get Tested? To screen for or diagnose a variety of conditions that can affect white bloo d cells (WBC) such as an infection infection,, inflammation or a disease that affects the production or o r survival of WBCs; to monitor treatment of a blood disorder or to monitor therap y that is known to affect WBCs
When to Get Tested? As part of a complete blood count (CBC), (CBC), when you have a routine health examination; when you have any number numbe r of signs and symptoms that may be related to a condition affecting WBCs such as infection, inflammation, or cancer; when you have a condition or are receiving treatment that is known to affect WBCs
Adult
4,500-11,000 white blood cells per microliter (mcL)
Platelet Count Why Get Tested? To determine the number of platelets in a sample of your blood as part p art of a health exam; to screen for, diagnose, or monitor conditions that a ffect the number of platelets, such as a bleeding a bleeding disorder , a bone a bone marrow disease, disease, or other underlying condition
When to Get Tested?
As part of a routine complete blood count (CBC); (CBC); when you have episodes of unexplained or prolonged bleeding or other symptoms that may be due to a platelet disorder It may be ordered when a person has signs and symptoms associated with low platelets or a bleeding disorder such disorder such as:
Unexplained or easy bruising Prolonged bleeding from a small cut or wound Numerous nosebleeds Gastrointestinal bleeding (which can be detected in stool samples) Heavy menstrual bleeding Small red spots on the skin (petechiae) — — may may sometimes look like a rash Small purplish spots on the skin (purpura) caused b y bleeding under the skin
Testing may also be done when it is suspected that an individual has too many platelets. An excess of platelets can cause excessive clotting or sometimes bleeding if the platelets are not functioning properly. However, people with too many platelets often have no signs or symptoms so the condition may be found only when a platelet count is done as part of a health check or for other reasons.
Adult
150,000-450,000/microliter
Hemoglobin
Why Get Tested? To evaluate the hemoglobin content of your blood as part of a general health checkup; to screen for and help diagnose conditions cond itions that affect red blood cells (RBCs); if you have anemia or polycythemia,, to assess the severity of these conditions and to monitor response to treatment polycythemia
When to Get Tested? With a hematocrit or as part of a complete blood count (CBC), (CBC), which may be ordered as part of a general health screen; when your doctor suspects that you have a condition such as anemia (decreased hemoglobin) or polycythemia (increased hemoglobin); at regular intervals to monitor disease or response to treatment
PT and INR
Why Get Tested? ®
To check how well the blood-thinning medication (anticoagulant anticoagulant)) warfarin (COUMADIN ) is working to prevent blood clots; to help detect and diagnose a bleeding a bleeding disorder
When to Get Tested? When you are taking warfarin or when your doctor suspects that you may have a bleeding disorder A prolonged PT means that the blood is taking too long to form a clot. This may be caused by conditions such as liver disease, disease, vitamin K deficiency, deficiency, or a coagulation factor deficiency. The PT result is often interpreted with that of the PTT in determining what condition may be present.
Interpretation of PT and PTT in Patients with a Bleeding or Clotting Syndrome Syndrome PT result
ptt result
Prolonged Normal
Normal
Prolonged
Prolonged Prolonged
Normal
Normal or slightly prolonged
Examples of conditions that may be present Liver disease, decreased vitamin K, decreased or defective factor VII, chronic low-grade disseminated intravascular coagulation (DIC), (DIC) , anticoagulation drug (warfarin) therapy Decreased or defective factor VIII, IX, or XI, von Willebrand disease (severe type), presence of lupus of lupus anticoagulant Decreased or defective factor I, II, V or X, severe liver disease, acute DIC May indicate normal hemostasis hemostasis;; however, PT and PTT can be normal in conditions such as mild deficiencies in other factors and mild form of von Willebrand disease. Further testing may be required to diagnose these conditions.
PTT Why Get Tested? As part of an investigation of a possible bleeding possible bleeding disorder or disorder or thrombotic thrombotic episode; episode; to monitor unfractionated (standard) heparin anticoagulant therapy
When to Get Tested? When you have unexplained bleeding or blood clotting; when you are on unfractionated (standard) heparin anticoagulant therapy; sometimes as part of a pre -surgical screen
Urinalysis Why Get Tested? To screen for metabolic and kidney disorders and for urinary for urinary tract infections (UTIs)
When to Get Tested? During a routine physical or when you have symptoms of a UTI, such as abdominal pain, back pain, frequent or painful urination; as part of a pregnancy a pregnancy check-up, a hospital admission, or a pre-surgical work-up
