The disorder and the following elements: pathophysiology, signs/symptoms, progression trajectory, diagnostic testing, and treatment options
The primary pathophysiologic mechanisms for the patient’s condition for these signs emanated from a gradual process of atherosclerosis (arterial disease) (Ambrose & Singh, 2015; Sayols-Baixeras, Lluís-Ganella, Lucas, & Elosua, 2014). The arterial condition develops and progresses for several years before any acute outcome can be experienced. The condition is associated with slow inflammation of the inner lining of arteries, and the condition increases with the well determined several risk factors as noted in the patient, including smoking, genetics, diabetes, high cholesterol, obesity, and high blood pressure (Ambrose & Singh, 2015; Sayols-Baixeras et al., 2014).
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In this case, the patient has experienced a gradual progression that has led to the slow thickening of the inner layers of the arteries. As such, the lumen becomes narrow. The arterial condition leads to acute myocardial infarction (AMI) and sudden cardiac death (SCD) (Ambrose & Singh, 2015). The condition further causes weaknesses of the vital constituents of arteries and eventually changes the flow in the arteries. Overall, the pathophysiologic for cardiovascular disease involves some high-risk plaques and inflammation among patients.
Sign / Symptoms
Angina (chest pain) is the major symptom of cardiovascular disease. Patients may not be diagnosed with cardiovascular disease until they suffer angina, heart attack, heart failure, or stroke. Besides, shortness of breath and pain in the jaw, neck, back, throat, and upper abdomen are also common symptoms. Patients may also experience numbness, coldness, weakness, or pain in the legs or arms if blood vessels in those sections are constricted.
One must be recognized that cardiovascular disease does not have a linear predictable progress path. The enhanced increment in stenosis severity associated with thrombosis could be used to explain the progression. The rapid progress of the condition could be responsible for multiple acute clinical presentations of acute myocardial infarction and sudden cardiac deaths.
The first phase of the condition marks the onset of the symptoms, disease diagnosis, and the start of treatment. The phase is observed when patients present themselves at the emergency room with life-threatening angina and shortness of breath. Some patients may die during this phase.
In the second phase, the patient requires care of physicians. Stenosis progression is normally observed whether it is clinically related to acute coronary outcomes or not. It is a strong indicator of cardiovascular risk in patients.
Atheromatous plaques related to enhancing coronary artery condition progression usually show clear anatomical or functional impairment noted that is normally classified as unstable or vulnerable. As such, the patient has a high propensity to acute disruption or enhanced thrombogenicity, resulting in a case of serious coronary outcomes. Plagues are now considered as extremely active during the disease progress phases.
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In the third phase, the patient experiences increased symptoms related to poor heart function. Treatment is extremely important to restore stability. An implantable device or stent placement may be used to enhance functional aspects of the heart specifically in life-threatening cases.
A few cases of fibrous cap rupturing have been observed, particularly in patients with angina. Other coronary events may follow with serious impacts, leading to further impairment of the heart.
In the fourth phase, the patient experiences further functional impairment characterized by increased symptoms and reduced physical activity irrespective of optimal care. Further, treatment involving cardiac transplants could be an option. It is also imperative to assess the right period for prognosis in the fourth phase. It could be difficult to engage the patient during this period, but enhanced care and interventions are necessary.
The assessment of vulnerable plaques could help in determining the potential risks of coronary events. The outcome can be used for rational management of the patient’s cardiovascular disease. The patient may experience more cases associated with myocardial infarction and ulcerated plaques.
The final phase involves an open review of the care plan and its intended goals. In this case, physicians now focus more on symptom management rather than interventional therapies. The patient will receive supportive and palliative care required. There are possibilities of multi-organ impairment. Physicians will also concentrate on resuscitation status and assessment of cardiac devices. Cardiac devices may be deactivated when the family agrees, triggered device removal is noted, and notable patient discomfort. The final phase is normally characterized by rapid progress and, thus, the treatment plan should be designed in advance. Otherwise, patient care delivery may be disorganized.
Although multiple diagnostic tests are available for the patient, cardiac catheterization, angiography, electrophysiology, chest X-ray, blood and urine tests, and physical examinations are highly recommended (Chin et al., 2012).
According to available evidence, physicians should not conduct diagnostic tests with “resting or stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging” (Chou, 2015, p. 438) for asymptomatic due to false-positive results.
Several treatment options are available for cardiovascular disease. Non-invasive treatment options are generally physical activities, healthy diets, and medication. It is imperative to note that these non-invasive treatment options also include complementary and alternative medicine (CAM) treatment options, which are generally not included in conventional medicine (Rabito & Kaye, 2013). These treatment options can also assist in managing risk factors, including “hypertension, high LDL-cholesterol, smoking, diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use” (Rabito & Kaye, 2013, p. 1). The patient in this case does not drink. Overall, CAM will assist the patient to control depression, anxiety, stress, and pain.
The disease can also be managed by minimally invasive treatment options, which need catheterization. The physician gains access to the heart via arteries located in the arms or legs to unblock them or insert stent when necessary.
Surgical procedures are also considered for a patient with the condition. In this case, an operational procedure would involve opening the patient’s chest to identify and repair the impaired tissues, arteries, and/or vessels.
An emerging treatment option for the cardiovascular disease involves gene therapy. The therapy is necessary for patients who have not benefited from conventional treatment options. Such patients may experience serious cases of angina pectoris even when they are under optimal medical care. Hence, they are no longer managed with coronary artery bypass graft surgery or percutaneous coronary intervention (Wolfram & Donahue, 2013).
The treatment that could soon help such patients is referred to as therapeutic angiogenesis. Physicians administer genes for angiogenic development to enhance additional vessel growth. Some positive preclinical outcomes had shown that gene therapy could be used to overcome limitations of other treatment options. However, multiple failures noted in the gene therapy have reduced its efficacy and possible use. Overall, it is concluded that angiogenesis is an intricate treatment option that relies on the effective timing of several developmental factors noted on receptors to enhance and then maintain new vessel developments (Wolfram & Donahue, 2013).
The disorder from normal development
As opposed to the normal heart development, cardiovascular disorder emanates from improper arrangement or separation of cardiac precursors during growth and by the degeneration of cardiomyocyte activity in adulthood (Dixon, Dick, Rajamohan, Shakesheff, & Denning, 2011). Specifically, it has been observed that the heart has minimal ability to regenerate. Consequently, there is an urgent need to comprehend the genetic processes of cardiomyocyte specification effectively (Dixon et al., 2011).
It has also been observed that the growth abnormalities are associated with abnormal activities or functions of some cells – cardiac myocardial progenitor cells (Degenhardt, Singh, & Epstein, 2013). For instance, normal heart development does not display defects observed in the hypoplastic right ventricle, which generally originate from defective developmental mechanisms specific to the second heart field derivatives (Degenhardt et al., 2013). Also, evidence from normal cardiac growth shows vital factors noted at progressive stages of cardiomyocyte arrangement and lineage restriction.
The physical and psychological demands the disorder places on the patient and family
As the patient indicates, the cardiovascular disease leads to physical inactivity. In most instances, the major drawback of physical inactivity on patients and family are related to financial burdens that could negatively affect the treatment and well-being of the family.
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Psychological demands are linked to emotional and social support. Patients who fail to receive psychological demands often suffer depression. Depression is also linked to morbidity and mortality in patients and families, especially if the condition becomes acute. Further, anxiety is also noted in patients, and it could contribute to deaths.
It is acknowledged that depression, anxiety, lack of social support, social isolation, some hostile behaviors, and other chronic conditions are generally regarded as elements of stress. In the case study, a lack of social support is also noted.
Both physical and psychological demands have negative outcomes for cardiovascular disease. These risks may increase as the disease progresses to advanced stages.
The key concepts that must be shared with the patient and family to achieve optimal disorder management and outcomes
The patient and members of his family will have to make critical decisions related to cardiovascular disease and other possible complications to manage health outcomes. The patient and members of his family will learn about cardiovascular disease and engagement with other stakeholders.
They will play a critical role in comprehending possible causes and progression of the disease, health management, engaging inappropriate activities, treatment for acute events, and aspects of managing chronic episodes. The patient and the family must acknowledge these responsibilities and support them for optimal management of the disorder.
In this case, it is highly recommended that the patient and family members should focus on health literacy about cardiovascular disease, shared decision-making, and effective self-management. For enhanced health literacy, decision-making, patient involvement, and education for self-management, the following aspects will be highly important. The patient and family members will require written information to support treatment and decision-making, sources of relevant information, effective communication, decision-making aid for patients, and self-management training.
Key interdisciplinary team personnel needed and how this team will provide care to achieve optimal disorder management and outcomes
The current chronic condition of the patient requires integrated and coordinated interventions to deliver the best outcomes. As such, based on patient-centered cardiovascular disease care, the following interdisciplinary team personnel are required for optimal care.
Biomedical care personnel will perform the following functions. They will conduct assessment and documentation of biomedical factors based on the confirmed diagnosis and further assess the functional capacity of the patient, including physical activity. The personnel will also be responsible for providing tailored medical management, including developing a treatment plan to manage comorbid and related conditions, prescribing medicines, routinely providing preventive care, and developing personalized treatment plans.
Self-care education and support personnel will also be required to assess and document self-management status and advance self-care education and counseling, such as ensuring that the patient understands cause and consequences, activities and medicine to avoid among others. They will also encourage a personalized care action plan to monitor weight, for instance.
Psychosocial care personnel will be responsible for determining the needs of patients. These may include assessment of concurrent depression, social support requirements, and coping strategies among care providers. Care should be developed to meet the unique attributes of the patient, including social and economic status.
The patient will also require nutritionists to manage his poor diets.
Physiotherapists will also be required to assist the patient to perform physical activities because of his current physical weakness.
In the advanced stage, palliative care personnel will assess and document care needs, determine treatment goals, and care with the patient and family members. The patient will also need regular assessment of cardiovascular disease.
Facilitators and barriers to optimal disorder management and outcomes
Health awareness and comprehension of specific consequences of not adhering to treatment plans and cases of deteriorating conditions are imperative facilitators to effective care (Siabani, Leeder, & Davidson, 2013).
Patients and families that lack knowledge of the cardiovascular disease, particularly on diets, physical activities, risk factors, and misconceptions about cardiovascular disease are critical barriers. Moreover, failures to understand symptoms and outcomes also limit management and outcomes.
Social practices may undermine healthy practices. For instance, non-adherence, failure to ask for help, and poor diets will negatively impact care outcomes. Conversely, supportive social factors will enhance the quality of care.
Supportive environments, including the family, care providers, and neighbors will assist the patient to realize optimal care outcomes.
Strategies to overcome the identified barriers
These barriers can be overcome by enhanced patient education. The patient must understand cause and consequence relationships, the importance of adherence to recommended diets, physical activities, social support, and avoidance of risk factors.
Care providers will also enhance their relationship with the patient and family members through effective communication.
Care Plan for Cardiology Clinical Case
- A comprehensive and holistic recognition and planning for the disorder
The objective of the care plan is to improve the quality, safety, and patient experience.
Continuous assessment of the patient condition
- Administering effective treatment for cardiovascular disease
Several drugs are available, but physicians must opt for the most effective one based on the condition of the patient. These medications include ace inhibitors, antiarrhythmic drugs, antiplatelet drugs, beta-blockers, aspirin, thrombolytic therapy, and diuretics, and warfarin among others.
- The patient may require additional surgery if the stent is no longer effective.
Physical and psychosocial health support
Physicians and nurses should visit the patient and assess their condition and feelings about status. They should determine the best education options and exercise approaches. Moreover, the patient may need telephone support and sustained follow-ups. He should also be introduced to other groups of people with the same cardiovascular condition to avert his social isolation. A community-based support center would be effective for the patient after his discharge from the hospital to assist in monitoring progress, adherence to medication and diet plans, as well as risk factors, control plans.
The patient should bring his wife along, specifically during patient education on cardiovascular disease, self-management, and related outcomes.
The patient should go for further assessment to determine his physical and psychosocial health requirements a few weeks after the discharge. Moreover, he should also attend patient education on related risk factors, such as obesity, type 2 diabetes, gene factors, and high blood pressure. The patient’s GP should be regularly updated on outcomes.
The patient will also receive the necessary physical support conducted by a physiotherapist from the community support center. The patient will be encouraged to have specific exercise regimens that can be conducted at home.
Physicians will also receive home visits and review of progress to determine outcomes and make appropriate medication therapy. The patient must focus on regular assessments with the care providers and with cardiologists to ensure a continuous management plan for the cardiovascular condition.
The patient should be managed through effective communication to ensure optimal management of the cardiovascular condition and care outcomes.
The socio-cultural background could negatively affect treatment and related outcomes. Specifically, the plan is designed to enhance patient adherence to treatment. The physician will have to conduct a realistic evaluation of the patient’s knowledge and comprehension of the treatment and exercise regimen and their beliefs about the condition. This approach would ensure that the care plan is designed to provide optimal care for the patient. For instance, he must rest adequately rather than strive to provide for his sick wife while still in poor health.
Care providers will allow patients to narrate their experiences to enhance communication. Consequently, information about the patient’s attitude, beliefs, cultural practices, isolation, social support, depression, anxiety, and emotional issues will be effectively addressed.
Lifestyle and health behaviors
These will generally address risk factors observed in the patient. These will include “hypertension, high LDL-cholesterol, smoking, diabetes, overweight and obesity, poor diet, and physical inactivity” (Rabito & Kaye, 2013, p. 1).
- The patient currently smokes, and smoking is a major risk factor for cardiovascular disease. The patient must reduce cigarette smoking and ultimately stop.
- The poor diet can lead to obesity (in this case, the patient has android obesity) and, therefore, the patient must focus on healthy diets and regular physical activities. The patient must now focus on foods rich in nutrients, specifically fruits, and vegetables.
- Regular physical activity is known to aid in reducing the risks of cardiovascular disease. The patient must be taught the importance of being active throughout his life. Past physical activities cannot sustain his current health needs. He should at least consider 30 minutes of physical exercise for five or more days every week.
- The patient does not drink or abuse drugs. However, the current depression and stress could result in drug and alcohol abuse. Hence, patient education must also account for such risk factors.
This care plan is based on the notion that no single intervention approach can enhance treatment and patient adherence. As such, successful outcomes will largely depend on designing and implementing unique attributes of the patient, cardiovascular conditions, and effective treatment regimens.
Ambrose, J. A., & Singh, M. (2015). Pathophysiology of Coronary Artery Disease Leading to Acute Coronary Syndromes. F1000Prime Reports, 7, 08. Web.
Chin, D., Battistoni, A., Tocci, G., Passerini, J., Parati, G., & Volpe, M. (2012). Non-Invasive Diagnostic Testing for Coronary Artery Disease in the Hypertensive Patient: Potential Advantages of a Risk Estimation-Based Algorithm. American Journal of Hypertension, 25(12), 1226-1235. Web.
Chou, R. (2015). Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging: Advice for High-Value Care From the American College of Physicians. Annals of Internal Medicine, 162(6), 438-447. Web.
Degenhardt, K., Singh, M. K., & Epstein, J. A. (2013). New Approaches under Development: Cardiovascular Embryology Applied to Heart Disease. Journal of Clinical Investigation, 123(1), 71–74. Web.
Dixon, J. E., Dick, E., Rajamohan, D., Shakesheff, K. M., & Denning, C. (2011). Directed Differentiation of Human Embryonic Stem Cells to Interrogate the Cardiac Gene Regulatory Network. Molecular Therapy, 19(9), 1695–1703. Web.
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Sayols-Baixeras, S., Lluís-Ganella, C., Lucas, G., & Elosua, R. (2014). Pathogenesis of Coronary Artery Disease: Focus on Genetic Risk Factors and Identification of Genetic Variants. Application of Clinical Genetics, 7, 15–32. Web.
Siabani, S., Leeder, S. R., & Davidson, P. M. (2013). Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies. SpringerPlus, 2, 320. Web.
Wolfram, J. A., & Donahue, J. K. (2013). Gene Therapy to Treat Cardiovascular Disease. Journal of the American Heart Association, 2, e000119. Web.