Introduction
The risk factors of chronic bronchitis are smoking and exposure to dust, fumes, and infections, which irritate the airway system. The symptom and signs presentation of this condition include cough with sputum, chest tightness, and pulmonary hypertension. In addition, people with the illness appear edematous and cyanosed. Complications associated with this disease are respiratory failure, emphysema secondary polycythemia, pulmonary hypertension, and cor pulmonale.
Coronary heart diseases and hypertension are risk factors for cardiac failure, which is associated with poor ventricle functional capacity, and increased exercise intolerance. In addition, low cardiac output and progressive damage of end organs occur in people with chronic cardiac failure, it mostly causes death for people having pulmonary arterial hypertension (Mozaffarian et al., 2015). Right-sided heart failure is linked to right ventricle myocardial infarction, postcardiotomy shock, and pulmonary embolism.
Clinical Findings, Treatment, and Recommendations for M.K Chronic Bronchitis
History of smoking, poor diet, chronic cough, and severe cough in the morning coupled with the sputum correlates with Mrs. M. K’s bronchitis condition. In addition, the clinical findings, which are high hematocrit, hba1c, and abga also correspond to this condition. There is no cure for this disease, however, it can be managed using a treatment plan, which consists of bronchodilator and theophylline medication. The bronchodilator has an active drug component that aids the patient to breathe easily by opening up the lung’s airway, they are taken in using inhalers. Theophylline relaxes the muscles in the airway by allowing entry of sufficient air to ease severe breath shortness. If the symptoms exacerbate after using these medications, then asteroid in the form of a pill or a bronchodilator is prescribed. Furthermore, antibiotics are given to the patient to avoid further bronchi infection.
The inhaled corticosteroid consists of beclomethasone (400 μg BD), or fluticasone, or budesonide. However, for patients with severe symptoms, 30 mg oral prednisolone is prescribed for two weeks. There are different types of bronchodilators based on the type of drugs it contains. For instance, some are filled with Inhaled b agonist in form of salbutamol (200 μg after every 6 hours) or inhaled antimuscarinic consisting of ipratropium (40 μg after 4 hourly) (Stout et al., 2016). Additionally, 200 mg of mucolytic agents such as N-acetylcysteine or bromhexine may be prescribed.
Mrs. M.K should be enrolled in a pulmonary rehabilitation program, which will help in improving her breathing and general well-being. The activities in this therapy include nutritional counseling, exercise, counseling, and breathing strategies. Additionally, a follow-up in a healthcare facility every month for at least 3 months for the patient is recommended. In the clinic, the smoking status or efforts for cessation, adherence to medication, frequency of exacerbation, presence, and effects of other comorbidities, and efficacy of medication are accessed. Appropriate advice is then offered by healthcare workers. Other actions to be undertaken may include weight reduction through exercises, receiving an influenza vaccine, and long-term domiciliary oxygen.
Pathogenesis of Heart Attack
There are two major types of heart failure, left heart failure, and right-sided heart failure. The left-sided is the most common, it is further classified into two groups, which are systolic and diastolic failure. A cardiac dysfunction causing reduced ejection fraction (HFrEF) due to the inability of the left ventricle to contract is a systolic failure. The left ventricle loses its ability to efficiently contract hence enough blood for circulation is not pumped. Diastolic malfunctioning has preserved ejection fraction (HFpEF). However, in this kind, the left ventricle stiffens the muscles to hinder blood from filling the heart in the resting period.
Right-sided heart failure is elicited by diverse activities such as right ventricle cardiomyopathies, right ventricle infarction, and ischemia. Furthermore, the presence of pressure loading caused by cardiac lesions from pulmonary hypertension or pulmonic stenosis is attributed to cardiac failure pathology. Dysfunction of the right ventricle caused by left-sided heart disease is the major cause of mortality and morbidity in patients with heart conditions. In the case of Mrs. M.K, hypertension and chronic bronchitis triggered left heart side malfunctioning, which forced the right ventricle to be harder when pumping blood into the lungs. Consequently, resulting in failure.
Mrs. M.K is suffering from right-sided heart failure, which occurred due to the inability of the left heart side to function. Failure of the left ventricles causes a build-up of fluid in the lungs because blood is not pumped to the body. Consequently, the pressure moves back from the lungs into the heart where it damages the right side hence making pumping of blood impossible. This results in the backflow of blood into the veins to cause congestion and swelling in the ankles, legs, abdomen, and liver.
The patient is in stage 2 hypertension, which implies that his systolic pressure is more than 140 mm Hg and diastolic 90 or more (Benjamin et al., 2017). Current drugs used by M.K for hypertension are Lasix and Lotensin. Laxis is a loop diuretic, it aids the body to discharge water and salt when controlling blood pressure. This medicine is rarely used for treating hypertension. However, it is efficient in the treatment of patients with heart failure or impaired renal function. This drug also helps in controlling edema and shortness of breath. Lotensin is an Angiotensin-converting enzyme. It inhibits the production of angiotensin hormone, which narrows the body arteries. The mechanism of action of this drug is opening and relaxing blood pressure to lower blood pressure.
Lotensin lowers blood pressure by reducing the risks of nonfatal and fatal cardiovascular episodes, myocardial infarctions, and strokes (American College of Cardiology, 2017). These complications are increased by the elevation of blood pressure. Since the patient has elevated diastolic and systolic pressure, she was already at a higher risk of heart failure. Therefore, it was beneficial to reduce severe hypertension rapidly even by a smaller margin. Lotensin is more aggressive in lowering blood pressure relative to monotherapy drugs such as moexipril. Therefore, it is more suitable for people with comorbid factors such as hyperlipidemia and hypertension.
Impacts of the High Blood Pressure and Heart Failure on US Population
Heart failure is a condition that inhibits the heart from providing blood to all body parts, it takes several years for it to develop. The risk of this disease increases with the narrowing of vessels due to high blood pressure. The United States population is increasing over time, this expansion is attributed to an increase in births and immigration. Furthermore, the introduction of an affordable health care system has greatly increased life expectancy. Currently, the population of people aged 65 and above is increasing. Heart failure condition increases with age as a result of the development of risk factors such as coronary artery disease and hypertension. For this reason, the cardiac failure epidemic is likely to be experienced. Consequently, causing an increase in health service delivery costs in the country.
The lipid panel gauges the amounts of fatty substances and fats utilized by the body to synthesize energy. It measures triglycerides, low-density lipoprotein (LDL), total cholesterol level, and high-density lipoprotein (HDL) and triglycerides. Normal total cholesterol level should be 200 milligrams per deciliter (mg/dL) or less, more than 240 mg/dL is high while between 201 and 240 is considered at the borderline. HDL above 60 mg/dL level is the best because it protects against cardiac disease, 40 -59 is good while below 40 mg/dL is bad.
The ideal LDL level in the body is 100 mg/dL or less, between 160 and 189 mg/dL is high and dangerous while 130 to 159 mg/dL is at the borderline of being high. Mrs. M.K lipid panel results are total cholesterol 242 mg/dL (high), HDL 32 mg/dL (low), LDL 173 mg/dL (high), Triglycerides 1000 mg/dL (very high). According to these findings, she is at risk of developing conditions such as heart attack, cardiovascular diseases, and stroke. This is because she has low good cholesterol fats and more bad fats. Lower than 40 mg/dL of good cholesterol (HDL) increases the chance of developing heart diseases.
Lifestyle changes are key in reducing a person’s heart disease chance. These alterations may consist of exercise and eating a low cholesterol diet. Food with plant sterols, fibers, and low saturated fats and taking less than 200 mg of cholesterol helps in lowering LDL. Regular aerobic exercise can both lower bad cholesterol (LDL) and raise good cholesterol (HDL). Therefore, Mrs. M.K should be strict on eating a good diet and exercising to lower the levels of his bad cholesterol. The patient may also benefit from the intake of a low-sodium diet and cessation of smoking. In addition, the patient has to stop smoking because it is a risk factor for cardiac illness. People with better cholesterol levels can also develop heart illness. This is because there are other risk factors for the diseases such as smoking, diabetes, obesity, genetics, and high blood pressure. Thus, a long-term treatment strategy is recommended to modify cardiovascular mortality causes.
The patient has a higher risk of heart failure due to obesity, hypertension, chronic kidney disease, smoking history, diabetes, and age. Immediate treatment of Mrs. M.K should aim at reducing blood pressure to about 130/80 mm Hg to avoid strokes. Therefore, an effective cholesterol-lowering agent, which is proprotein convertase subtilisin-Kexin type (PCSK99) is to be used. This will drug helps in lowering LDL-C levels to ≥70 mg/dL. Alternative medication is oral therapies with ezetimibe and statins drugs. Additionally, hematocrit and hemoglobin should be increased since anemia increases the risk of cardiac attack. The medicine empagliflozin should be given to reduce HbA1c.
Findings Correlating with both Hypertension and Type 11 Diabetes Mellitus
Type 11 diabetes and hypertension are features of metabolic syndrome, they are both characterized by obesity and cardiovascular disease. In addition, they all increase the risk of retinopathy, nephropathy, and stroke. In the case of Mrs. M.K medical condition, frequent urination, blood pressure at 158/98 mmHg, which is high, and excessive peripheral edema are effects of both hypertension and type 11 diabetes mellitus. The patient is obese, she weighs 225 lbs, 180.3 and above is an indication of obesity in 5’5’’ people while 111.2-150.2 lbs are underweight. A normal person should have between 150.2 -180.3 lbs. Thus, heart failure and obesity featured in the case correlate with both conditions.
The normal glycosylated hemoglobin level in the blood should be less than 7%. Thus, a 7.3 % recorded in the findings indicates that the patient had poorly controlled diabetes mellitus. Persistence with type 11 diabetes mellitus confirms the absence of proper production of insulin, which may lead to a decrease in glucose absorption rate from vessels. This in turn leads to the reduction of blood glucose amount.
The red blood cells play a significant role in transferring oxygen to all parts of the body. A high or low erythrocytes counts in the blood indicate a presence of disease or metabolic condition. The hematocrit is the volume of blood that contains the red blood cells, Mrs. M.K has a hematocrit percentage of 57%, which is high. Normal hematocrit in men ranges between 45% to 52% and 37% to 48% in women.
The presence of high hematocrit levels and red blood cell overproduction contributes to systemic hypertension. In addition, higher hematocrit level has been shown to increase the risk of type 2 diabetes. Abnormalities in the metabolism of carbohydrates are linked to hypertension and type 11 diabetes mellitus. This is because insulin resistance plays a major role in hypertension pathogenesis. Insulin level elevation is a risk factor for heart disease. Furthermore, it increases exchangeable sodium, which causes hypertension in diabetic people.
Conclusion
Coronary heart disease and Hypertension are the strongest risk factors for cardiac failure. In women, hypertension exacerbates the condition while in men myocardial infarction is riskier. Heart failures cause disability and personal suffering to survivors. It is prevalent in older people aged 65 years and above, this age group is insured through the Medicare program. Thus, the government also incurs losses due to the growing expenses on health care delivery as per the U.S per capita expenditure. Other risk factors associated with these conditions, which are common in aging people are obesity, hypertension, atherosclerotic cardiovascular disease, and diabetes mellitus.
Heart problem is a major health problem in U.S. Cardiac failure affects more than 6.5 million Americans aged 20 and above. Currently, there is improved survival of patients from myocardial infarction, which was the leading cause of cardiovascular diseases. The AHA projects an increase of cardiac prevalence in about 46% of the population (Benjamin et al., 2017) from the year 2012 to 2030. Currently, deaths caused by heart failure especially among the non –Hispanic black communities and men are on the rise (Centers for Disease Control and Prevention, 2015). There is a need therefore for a vibrant health promotion program to sensitize people on the importance of lifestyle changes such as exercise.
Changes in lifestyle to reduce the risk of heart failure include leaving unhealthy behavior such as tobacco smoking, avoiding food high in sodium, cholesterol, and fats, and reducing alcohol intake. People should also be vigilant in monitoring the signs of heart failure to avoid hospitalizations and complications. Common symptoms to be considered include shortness of breath while undertaking routine daily activities, being uncomfortable when lying down, excessive weight gain, swelling of the feet, ankles, or stomach, and a general feeling of being weak or tired.
References
American College of Cardiology (2017). Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Author.
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., & Isasi, C. R. (2017). Heart disease and stroke statistics—2017 update. Circulation, 135, 146-603. Web.
Centers for Disease Control and Prevention. (2015). Heart Failure. Web.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., & Huffman, M. D. (2015). Executive summary: heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation, 131(4), 434-441.
Stout, K. K., Broberg, C. S., Book, W. M., Cecchin, F., Chen, J. M., Dimopoulos, K., & Kuvin, J. T. (2016). Chronic heart failure in congenital heart disease: A scientific statement from the American Heart Association. Circulation, 133(8), 770-801.