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 must sleep on two pillows to get enough air.

Alterations in the Cardiovascular and Respiratory Systems

The cardiovascular and cardiopulmonary pathophysiological processes present a symbiotic relationship that influences the development of the symptoms presented by the patient. These processes may interact and affect the patient’s physiological functioning and the presentation of related symptoms. The early stages of the cardiovascular and cardiopulmonary pathophysiological processes include chronic inflammation of the airways and ventricles, leading to immune responses. This leads to changes in the small and large airways and the ventricles. The changes in the airways due to chronic inflammation include the impairment of mucociliary clearance and airway remodeling due to the deposition of bronchial connective material during repair following the immune response (Hough et al., 2020). The inflammation in the small airways leads to the contraction of the smooth muscles, bronchial hyperresponsiveness, and the risk of the soft tissue in the small airways rupturing. Within the alveoli, the inflammation leads to a build-up of macrophages and monocytes during an immune response. The macrophages’ and monocytes’ action within the alveoli can contribute to further inflammation, which may destroy the alveoli walls, leading to alveolar and surface reduction for gaseous exchanges.

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Ventricular and vascular inflammation results in the dilation of the right ventricle, causing impairment of the proper ventricular functions. The inflammation is further associated with endothelial destruction, leading to vascular constriction and increased pulmonary vascular resistance. This results in pulmonary hypertension with similar effects on the right ventricle. These cardiovascular pathophysiologic processes determine ventricular performance and ventricular filling and discharge pressure. The changes in the left ventricle lead to left ventricular systolic and diastolic dysfunction, causing elevated left atrial pressure and pulmonary congestion, risking congestive heart failure (Flint et al., 2019). In addition, the remodeling of the airways, the rupturing of the alveoli, and endothelial destruction of the blood vessels reduce the effectiveness of gaseous exchange and lead to hypoxia and associated symptoms due to reduced oxygen supply. Congestive heart failure and impairment of lung functions are presented with dyspnea and hypoxemia. The failing cardiovascular functions may cause the small blood vessels to leak fluids into the surrounding tissues. On the other hand, the patient’s failure to take their diuretics further impairs their body’s ability to get rid of sodium and water, leading to the swelling of their hands and feet. Therefore, patients with congestive heart failure are likely to present symptoms of pulmonary disease due to the related pathophysiological mechanisms, such as shortness of breath, peripheral edema, and abdominal swelling presented by the patient in the case.

Racial/ethnic variables may play a critical role in physiological functioning. However, race or ethnicity has no impact on cardiopulmonary diseases. The research focused on cardiopulmonary disease disparities based on race, such as the severity of the disease in affected patients, disease comorbidity, and the outcomes of care based on the treatment provided, and has proved that race does not impact physiological functioning. For instance, Egbuche et al. (2021), in a COVID-19-focused study, found that the black race had an increased risk of in-hospital cardiac events and mortality when hospitalized with COVID-19. Additionally, Nasr et al. (2022) found that race was not a factor in the adverse postoperative outcomes in children with congenital heart disease undergoing noncardiac surgery. However, the racial disparities in cardiopulmonary diseases have been linked to other factors such as socioeconomic status and access to healthcare. For instance, a study by Phillips et al. (2021) focused on establishing whether an association exists between the black race and the clinical severity and management of acute pulmonary embolism; hospitalized black patients had a higher severity of the disease as compared to white patients. However, the severity was associated with the likability of receiving an intervention before the disease progressed.

References

Egbuche, O., Abe, T., Nwokike, S. I., Jegede, O., Mezue, K., Olanipekun, T., Onuorah, I., & Echols, M. R. (2021). Racial differences in cardiopulmonary outcomes of hospitalized COVID-19 patients with acute kidney injury. Reviews in Cardiovascular Medicine, 22(4), 1667–167