Scenario: A 76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now has to sleep on two pillows in order to get enough air. Please do a 1- to 2-page case study analysis. In your Case Study Analysis related to the scenario provided, explain the cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms, any racial/ethnic variables that may impact physiological functioning, and how these processes interact to affect the patient.
Case Study Analysis – Congestive Heart Failure
From the case study, the patient reported weight gain, shortness of breath, peripheral edema, and abdominal swelling. These symptoms the patient is experiencing are associated with cardiopulmonary and cardiovascular pathophysiologic processes due to congestive heart failure diagnosis. Congestive heart failure is a clinical syndrome whereby the heart is unable to pump the required amount of blood needed by the body. Failure to pump blood leads to accumulation in the peripheral tissues and lungs (King & Goldstein, 2020). This paper discusses the cardiovascular and cardiopulmonary pathophysiologic processes that lead to the clinical symptoms in the patient, race and ethical factors that relate to the diagnosis, and the processes of interaction are discussed.
Cardiovascular and Cardiopulmonary Pathophysiologic Processes
Firstly, peripheral edema and abdominal swelling can be attributed to ineffective blood ejection by the heart, leading to increased pressure in the veins. This causes fluid leakage into the surrounding tissues, leading to edema of the legs and ankles and abdomen swelling (King & Goldstein, 2020). Also, due to the fluid accumulation, the patient gains weight. Secondly, shortness of breath can be a result of pulmonary congestion. Fluid accumulation in the lungs causes pulmonary edema and limits gas exchange, reducing oxygen perfusion in the tissues and resulting in breathlessness (King & Goldstein, 2020). Furthermore, the pulmonary edema and fluid accumulation in the alveolar and interstitial spaces cause significant respiratory decompensation and dyspnea.
Racial and Ethical Variables
Racial and ethnic factors play a part in influencing the severity, prevalence, and management of cardiovascular diseases. Race is a sociocultural construct that lines up people in groups by socially perceived or self-identified physical manner. Ethnic and racial minorities have the highest prevalence, incidence, and hospitalization rate due to heart failure. Even though there have been improved therapies and survival, the disparity in mortality rates in minority races and ethnicities has increased over time. Some ethnic and racial groups are more susceptible to heart failure because of their socioeconomic disparities, healthcare access, and genetic makeup. For instance, African Americans have a 25% higher prevalence of cardiovascular disease compared to Caucasians (Malik et al., 2022). Moreover, cultural factors also affect medication adherence. Patients from specific backgrounds may have cultural practices and beliefs that affect their willingness to take medication (Malik et al., 2022).
Processes Interactions
Refusal to take diuretics due to the increased urination frequency is the core cause of intensifying congestive heart failure symptoms. Diuretics help in the improvement of hemodynamic status by reducing vascular congestion and improving the afterload, preload, and myocardial contractility. The interaction of the cardiovascular and cardiopulmonary processes is observed in the patient’s signs and symptoms (King & Goldstein, 2020). The cardiovascular process is affected by congestive heart failure, which leads to the accumulation of fluid in the abdomen and the lungs. In congestive heart failure, fluid accumulation can be mainly attributed to the dysfunction of the right side, left side, or biventicular. Pulmonary pressure increases due to left ventricular dysfunction, while tachypnea and dyspnea are a result of pulmonary congestion. When the peripheral circulation decreases, peripheral malperfusion and renal dysfunction develop (Schwinger, 2021). The fluid accumulation in the lungs then limits gaseous exchange, leading to shortness of breath, which forces the patient to use more pillows to support her breath (King & Goldstein, 2020). Overall, the quality of life of the patient is decreased, and the sleep patterns and daily activities are affected.
References
King, K. C., & Goldstein, S. (2020). Congestive heart failure and pulmonary edema. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554557/
Malik, A., Brito, D., Vaqar, S., & Chhabra, L. (2022). Congestive heart failure. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430873/
Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular Diagnosis and Therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302