St. Michael’s College of Laguna School of Nursing and Midwifery A Partial Fulfillment in Related Learning Experience III
A Case Study of Hypertensive Cardiovascular Disease (HCVD)
Submitted by: Angelique A. Malabo Airish Nyn Manzo BSN3B Group8
Submitted to: Sir Lloyd Lopez
29November2008
St. Michael’s College of Laguna School of Nursing and Midwifery INTRODUCTION Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the heart or blood vessels (arteries and veins). [1] 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 have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in the same hospital. Most countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer. It is the number one cause of death and disability in the United States and most European countries (data available through 2005). 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. Hypertensive cardiovascular disease also known as hypertensive heart disease occurs due to the complication of hypertension or high blood pressure. In this condition the workload of the heart is increased manifold and with time this causes the heart muscles to thicken. The heart continues pumping blood against this increased pressure and over a period of time the left ventricle of the heart enlarges and this in turn causes the blood pumped by heart to reduce. If proper treatment is not taken at this stage then symptoms of congestive heart failure may be observed. High blood pressure or hypertension is among the top most factors associated with cardiovascular diseases. This can result in ischemic heart disease. High blood pressure is also a contributing factor to the eventual thickening of walls of blood vessels. This increases the possibility of heart attacks and strokes. Hypertensive cardiovascular disease is among the leading killers in present times. Around 7 people out of every 1000 suffer from this disease. Heredity is an important factor so far as people suffering from hypertension are concerned. Other factors include excessive consumption of salt and excessive stress.
St. Michael’s College of Laguna School of Nursing and Midwifery Symptoms It usually takes some time for the problem of high blood pressure to eventually lead to hypertensive cardiovascular disease and therefore high blood pressure is often called the silent killer. Eventually hypertensive heart disease can also lead to congestive heart failure. Some symptoms of hypertension and the eventual congestive heart failure include arrhythmias, shortness of breath, weakness and fatigue, swelling in lower extremities and greater frequency of urination during the night. Hypertensive cardiovascular disease may also result in ischemic heart condition and in this case there might be chest pain, sweating and dizziness, nausea and shortness of breath. Hypertrophic cardiomyopathy could also be a result of hypertensive heart disease. Tests Usually the first signal is elevated blood pressure together with a possibility of enlargement of the heart. Fluid within the lungs may also be found in preliminary examination by using the stethoscope and some abnormal heart sounds may also be detected. ECG is ordinarily done and this may show abnormal results in those who have possible hypertensive cardiovascular disease. Evidence of ischemia which is the lack of oxygen in the heart muscle may also be detected. Some other tests ordinarily conducted may include a chest X ray, a CT scan of the chest, echocardiogram and coronary angiogram. Treatment The primary aim of any treatment in hypertensive cardiovascular disease is reduction of blood pressure and then eventual control of the heart disease. The line of treatment will ordinarily depend on the condition such as whether there is angina or acute myocardial infarction. The line of treatment may include beta blockers, angiotensin converting enzyme inhibitors (ACE), calcium channel blockers, diuretics etc depending upon particulars of each individual case. The blood pressure is consistently required to be checked and kept under control in this condition. Likewise people experiencing hypertensive cardiovascular disease have to make certain changes in their lifestyle and diet patters. These would ordinarily include weight loss where obesity is identified, moderate exercise as per directions of the medical professional and adjustments in the diet. These adjustments would include intake of healthy food including vegetables, fresh fruits and low fat dairy items. Smoking is also a contributing factor to hypertension and therefore these lifestyle changes would have to include the patient quitting smoking. Consumption of fish, whole grains are also recommended. In the long run the outcome largely depends on the possibility and extent of complications. In hypertensive cardiovascular disease the treatment will depend largely on the degree of enlargement of the left ventricle. However some medicines such as
PATIENT’S PROFILE
St. Michael’s College of Laguna School of Nursing and Midwifery Name: Anicia N. Dilag Age: 55 Sex: female Civil status: Widow Nationality: Filipino Address: 205 Nielo St. Platero, Biñan, Laguna Religion: Roman Catholic Birthday: December 30. 1953 Attending Physician: Dr. Mina Admitting Physician: Dr. Leslie Bumarlong Date of admission: Time of Admission: 11:10 pm Admission Diagnosis: HCVD; AMI Final Diagnosis: HCVD; CAP Chief Complain: DOB Past Medication History: •
Hypertension
•
Hypercholesterolemia
Past Hospitalization: •
1997, exlap, ovarian cyst
Family History: •
Hypertension
History of Illness: Few hours PTC patient had an argument with her brother and then had DOB associated with chest pain prompting consult at ER and was admitted. After the assessment and series of examinations, the patient was diagnosed of having Hypertensive Cardiovascular Disease (HCVD).
ANATOMY AND PHYSIOLOGY
St. Michael’s College of Laguna School of Nursing and Midwifery An Introduction to the Cardiovascular System 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
St. Michael’s College of Laguna School of Nursing and Midwifery 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 allow them to perform more work by pumping out blood to the whole body.
Blood Vessels
St. Michael’s College of Laguna School of Nursing and Midwifery Blood Vessels 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 the superior 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. The aortic 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. Components of Blood Health conscious individuals should be especially concerned with maintaining a healthy cardiovascular system. While the heart, which is a powerful automatic pump, is the cardiovascular component we think of most often, the blood and the blood vessels are also vital to maintaining good health.
The average adult has between 5 to 6 liters of blood or blood volume. The blood carries oxygen and essential nutrients to all of the living cells in the body, and also carries waste products to systems that
St. Michael’s College of Laguna School of Nursing and Midwifery eliminate them. Most of the blood is made up of watery, protein-laden fluid called plasma. A little less than half of this blood volume is composed of red and white blood cells, and other solid elements called platelets. Platelets are responsible for coagulation of blood at the point of an injury to a blood vessel. Without platelets, our blood would not be able to clot and hemorrhaging or uncontrolled bleeding would result. Hemophilia is a genetic condition, which results in individuals with no ability to clot. Also called bleeders, these individuals must periodically administer a clotting factor to their blood to prevent the constant bleeding, which occurs.
How Blood Clots Let’s examine how platelets work to form clots. Here's a cut section of a small artery. The traffic going by includes red blood cells carrying oxygen; platelets, which come from white blood cell fragments; and clotting factors, which help the blood to clot. When a blood vessel becomes damaged, as shown here, the blood cells and plasma begin oozing out into the surrounding tissue. This begins the clotting process. Platelets immediately begin to adhere to the cut edges of the artery; they release chemicals to attract even more platelets. Eventually a platelet plug is formed, and the external bleeding stops. Inside, the clotting factors take a much more active role by creating a cascade of clotting activity. The clotting factors cause strands of bloodborne material, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals, and the blood clot dissolves after several days. While platelets play an important role in clotting, red blood cells carry on the important job of carrying oxygen and other nutrients to all the tissues of the body and carrying waste products to the organs, which remove them from the body.
How Red Blood Cells Carry Oxygen
St. Michael’s College of Laguna School of Nursing and Midwifery Red blood cells are the oxygen carriers. As they travel away from the heart, they traverse smaller and smaller arteries, finally arriving at the collections of microscopic blood vessels known as capillaries. Here, they exchange nutrients and oxygen for cellular waste products. The waste products are eventually eliminated from the blood stream through the urinary and respiratory systems. The exchange of oxygen and nutrients between the red blood cells and the surrounding tissues occurs through a process called diffusion. In diffusion, when capillaries contain a high concentration of oxygen and nutrients, while the surrounding tissues contain a lower concentration, Oxygen and nutrients leave the capillaries and enter the tissues. Conversely, when body tissues contain high concentrations of carbon dioxide and metabolic waste, while the capillaries contain a lower concentration, the waste products diffuse from the tissues into the capillaries and from there are carried by the venous system back toward the heart.
Blood Pressure The red blood cells transport oxygen and waste products by flowing through the blood vessels. What causes blood to flow through the vessels is blood pressure. Just as water flows through pipes from areas of greater pressure to lesser, so too the blood flows through the body from areas of higher pressure to areas of lower pressure. Blood pressure is measured both as the heart contracts, which is called systole, and as it relaxes, which is called diastole. A systolic blood pressure of 120 millimeters of mercury is considered right in the middle of the range of normal blood pressures, as is a diastolic pressure of eighty. In common terms, this normal measurement would be stated as "120 over 80".
St. Michael’s College of Laguna School of Nursing and Midwifery Normal blood pressure is important for proper blood flow to the body's organs and tissues. Each heartbeat forces blood to the rest of the body. The force of the blood on the walls of the arteries is called blood pressure. Blood pressure moves from high pressure near the heart to low pressure away from the heart. Blood pressure depends on many factors, including the amount of blood pumped by the heart. The diameter of the arteries through which blood is pumped is also an important factor. Generally, blood pressure is higher when more blood is pumped by the heart, and the diameter of an artery is narrow. Systolic pressure is measured when the heart ventricles contract. Diastolic pressure is measured when the heart ventricles relax. Stressful situations can result in a temporary increase in blood pressure. If an individual were to have a consistent blood pressure reading of 140 over 90, he would be evaluated for having high blood pressure. If left untreated, high blood pressure can damage important organs, such as the brain and kidneys as well as lead to a stroke.
PATHOPHYSIOLOGY
St. Michael’s College of Laguna School of Nursing and Midwifery
LABORATORY AND DIAGNOSTIC EXAMS
Date: 11/20/2008
St. Michael’s College of Laguna School of Nursing and Midwifery Result
Normal Values
145 5.9%
71-111mg/L 4.6-6.6
Examination HGT 5pm MHgb AIC
X-RAY DEPARTMENT Name: Anicia Dilag 55 Address: Platero Biñan, Laguna Exam: CHEST AP
Date: 11/16/2008 Sex:
F
Age: CS:
The lung fields are clear. The heart is transversely oriented and appears markedly enlarged, partly due to magnification being in the supine, AP projection. The aorta is tortuous and faintly calcified. The hemi diaphragms are elevated. Conclusion: Poor inspiratory effort, consider cardiomegaly (Left ventricle preponderance) atheromatous aorta.
MAGIC EIGHT Nov. 17, 2008
Examination B Glucose B BUN B Creatinine B Uric Acid B Cholesterol B Triglyceride B HDL Direct LDL
Result 8.0 mmo/L 2.6 66.5 vmo/L 318.9 vmo/L 2.8 mmo/L 1.2 0.8 1.8
Normal Values 3.9 to 5.8 2.5 to 6.5 35.0 to 150.0 150 to 420 0.0 to 5.2 0.7 to 1.7 0.0 to 1.6 0.0 to 3.34
St. Michael’s College of Laguna School of Nursing and Midwifery
