Pulmonary Blood Pressure: A Case Study

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

4) A chest X-ray reveals a cardiac silhouette that is normal in diameter. Does this rule out a possible problem with Martha's heart? Explain. No, a normal diameter of a cardiac silhouette does not rule out a problem with Martha’s heart. The heart adapts and will compensate for damage in order to still function optimally. The right ventricle, in this case, will become stronger in order to push the same amount of blood (stroke volume) through the narrowed pulmonary semi-lunar valve. This thickening doesn’t necessarily change the inner diameter.

Cardiovascular: No chest pain. She has dyspnea on exertion if she walks more than 20 steps. No orthopnea or claudication.

Lung function tests have revealed normal spirometry, gas transfer and static lung volumes. There appears to be a fall in pre-bronchodilator FEV1, but not so FVC and TLCO comparing back to 2007??. Maximal respiratory pressures are reduced indicative of respiratory muscle/diaphragm weakness. This is consistent with what has previously been observed and the previous diagnosis of mild left hemidiaphragm weakness. I note from Tony Dortimer’s most recent letter that the coronary angiogram

Over the years there has been some controversy on defining congestive heart failure due to a vast variability of the clinical signs and symptoms (Coronel, 2001). The American Heart Association defines it as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood” (Veronique, 2013). In this case report will critically analyse the general information of the giving condition in relation to the patient’s case.

A person's symptoms can provide important clues to the presence of heart failure. (Cadwallader p. 1143). Some of these include: JVD, SOB, frequent coughing when lying down, edema, acites, fatigue, syncope, vertigo, and sudden death. (Cadwallader p. 1142).

This method demonstrates impaired relaxation and filling because it delivers straight measurement of ventricular diastolic pressure. But, the balance of benefit, harm and cost can debate against its use to diagnose diastolic dysfunction. The other technique which can be used to diagnose diastolic heart failure is Doppler echocardiography. Doppler echocardiography is used to assess cardiac diastolic function, which can confirm the diagnosis of diastolic heart failure. For example, according to the online article, “Diastolic heart failure: challenges of diagnosis and treatment” states “echocardiographic measurement of tau, the time constant of left ventricular pressure decay during isovolunteric relaxation, can be performed to assess left ventricular stiffness.” Doppler echocardiography plays an important role to evaluate the characteristic of diastolic Trans-mitral-value- blood flow. Doppler echocardiography helps to measure the peak velocities of blood flow during early diastolic filling (E wave) and atrial contraction (A wave) and then ratio is calculated. When the heart is working normal, the early filling E-wave velocity is greater than the A-wave velocity and E to A wave ratio is 1.5. But, in diastolic dysfunction, this correlation reverses, because stiffness increases and the relaxation of heart occur slowly and E to A wave ratio decreases to 1.0. Also, as the diastolic

Congestive heart failure (CHF) is a weakness of the heart that has an insufficient circulation of blood throughout the body, which leads to the build-up of fluid in the lungs and edema in the surrounding tissues of the body. “As the intravascular pressure increases along with the amount of extravascular liquid, the lungs become less compliant and less permeable to oxygen, leading to respiratory discomfort (dyspnea), hypoxemia and tachypnea” (Garcia and Wright, 2010). As the condition deteriorates, the capacity of the interstitial space is exceeded, the fluid floods the alveoli and airways resulting in full blown CPE, an acute respiratory distress and a major medical emergency in heart failure patients” (Guyton 1991). There are two types of

“The usual clinical manifestation of heart failure is left ventricular dysfunction that occurs after some index event, such as myocardial infarction” (Chapa et al., 2014, p. 16). With the aging adults, like S.P., we have to be concern when they have presenting signs of heart failure, especially if they have not been diagnosed with one. Questions I may have to ask S.P. are what time of the day her fatigue and swollen ankles are worse. This is to determine if her fatigue and edema are cardiac related. Cardiac related fatigue is “worse in the evening, whereas fatigue from anxiety or depression occurs all day or is worse in the evening” (Jarvis, 2016, p. 472). Does her fatigue is accompanied with shortness of breath on exertion? Patient education

Nurse Vincent M. Vacca, Jr. aptly described in this issue of the Nursing Journal the significance of early detection and health management of people who are or are maybe suffering from Pulmonary Arterial Hypertension. He described PAH as a condition wherein a patient is having a mean pulmonary arterial (PA) pressure of greater than 25 mm

The patient’s chart did not state which type of cardiomyopathy he had a history of, but there are four types of cardiomyopathies. Dilated cardiomyopathy is when both heart ventricles are dilated and the heart’s pumping function is impaired because the ventricular walls stretch out to very thin widths (Dechant, 2016). Hypertrophic cardiomyopathy is where the walls of the ventricles thicken and grow inwards, and could impair the outflow of blood when the heart contracts (Dechant, 2016). Restrictive cardiomyopathy is when the ventricles stiffen in elasticity, restricting the inflow of blood into the ventricles at rest (Dechant, 2016). Finally, arrhythmogenic right ventricular cardiomyopathy could involve either ventricle and is when the myocardial tissue is replaced by fatty tissue, impairing overall ventricular function (Dechant, 2016).

The human body is a very complex organism composed of different types of systems and functions. All the functions that each system has, is what makes possible for the body to obtain life. One of the most important systems in one’s body is the circulatory system, where the heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey. The body’s circulatory system really has three parts: pulmonary circulation, coronary circulation, and systemic circulation. Each part must be working independently in order for them to all work together. However, when one of the parts of the circulatory system does not

To begin the search on Pulmonary Arterial Hypertension (PAH), pulmonary arterial hypertension was typed into PubMed and was limited for review articles in English. This approach was taken because the main interest of the search was the disease state and a review article was desired. The incidence of PAH is approximately between 5 to 52 cases per one million people. Also, the disease affects women more than men in a 2:1 ratio3. The pathophysiology of Pulmonary Arterial Hypertension occurs when vasodilators, like nitric oxide and prostacyclins, are under expressed and vasoconstrictors, like endothelin, are overproduced. The underproduction of vasodilators

Pericardial thickening more than 4mm is an indication of constriction in patient with appropriate symptoms and signs of right heart failure and mostly it occurs in right side. Pericardial thickening occurs after acute pericarditis and cardiac

Dilation of LV can be identified using CMR by assessing the ventricular volume and the systolic function. CMR can also characterize tissue which enables quantification of fibrotic tissue. This provides a measure of the severity of the disease and if viewed along with gadolinium (Gd) dye contrast, also allows differentiation between ischemic and non-ischemic cardiomyopathy. [7]