2973MSC Pathophysiology and Pharmacology

The patient in the present case study is a 68-year-old man whose name is Mr Deep Sindhu . He originally belongs to Indian but is now settles in Melbourne. He already has a list of chronic medical history which includes stable angina, type 2 diabetes, hypercholesterolemia, hypertension and stable angina. He suddenly complaint of chronic chest pain and the score being 8/10 itself denotes the pain is acute (Reinhardt et al., 2018). The current report aims to discuss pathophysiology as well as pharmacological interventions required for Mr Deep for the proper understanding and investigation of the case of the said patient with the said medical emergency. 

Firstly and formostly, he buddy nurse recommended to have the ECG and blood tests done for Mr Deep. ECG or electrocardiogram is one of the very common diagnostic procedures which are used in the medical line to see the abnormalities of the heart by detecting the electrical impulses which directly relates the heart beat of the person and can be later analyzed for the conclusion of the breathing pattern of the heart (Acharya et al., 2019). The said test is done in order to get the details of the irregular heartbeats, high blood pressure (Simjanoska et al., 2018)as well as the problems of shortness of breath, all of which are prevalent in the case study of the said patient according to the reports. To analyze the functioning of the heart with respect to the breathing problem as well as the chest pain, ECG was prescribed to be done. Blood tests are done to look for the level of troponin in the blood which is released from the damaged muscles of the heart. The more the level of the tropinin in the blood, the more damage to the heart has occurred (Shimoni et al., 2017). For the said reason, blood test was prescribed. Together, both the tests were done to detect the heart failure condition of the patient.

According to the tests which are discussed above it was concluded that he patient had a heart attack or heart failure condition. Heart failure or sometimes it is also known as the congestive heart failure takes place when the heart muscles are not able the pump the blood in the normal way because of any kind of abnormality (Rossignot et al., 2019). The abnormalities may of different types and of vast range. As for example the other medical conditions of the patient can be attributed to the development of the heart failure. There are established relation between the hypertension and heart failure condition because in the former medical condition, extra pressure is experienced by the heart and can be accounted for the abnormal pumping of the blood by the heart (Messerli et al., 2017). Type 2 diabetes as well as the medical condition of hypercholesterolemia can also be accounted for the heart failure condition as it leads to the narrowing of the arteries by providing resistance in the way of the flow of the blood by providing an extra lining of cholesterol inside the arteries (Hovland et al., 2017).

The condition of stable angina which is a type of coronary artery disease also leads to the narrowing down of the arteries of the heart and can be the reason for the heart failure of the patient. The pathophysiology revolves around the reduced force in concerned with the contraction because of the overloading of the ventricle with blood. In a normal healthy heart condition, the increased filling up of the ventricle leads to the increase in the cardiac output due to the increase in the contraction process but in the condition of heart failure, the said mechanism fails as the loading of the ventricles reach up to a point where the muscle of the heart becomes less efficient with respect to the contraction mechanism. The said inefficiency is due to the reduction in the ability of the cross linking of the actin as well as the myosin filaments in the condition of already over-stretched heart muscles. Reduction in the stroke volume can also occur due to the failure of the systole or diastole or both.

Increase in the end systolic volume has the reason of reduction in the contractility and the decrease in the end diastolic volume has the reason in the impaired ventricular filling of the heart. In the said condition, the heart starts working harder which increase the oxygen demand and thus, can be accounted for the shortness of breath in the patient (Dharmaranjan & Rich, 2017). The over stretched muscles of the heart results in the development of the increase in the stress of the which gives a response with respect to the conditions of myocyte hypertrophy as well as the death of the cells due to the initiation of the apoptosis and the process of the regeneration. This leads to the remodeling of the muscles. The decreased cardiac output also results in the initiation of different types of processes which includes the reactions of neurohumoral as well as the vascular mechanisms. The renal perfusion is also activated because of the decrease in the carotid baroreceptor.

The comorbities of the patient are already linked to the heart failure condition one of the major factor which leads to the development of heart failure is the age of the patient. Populations above 65 years become very much vulnerable to the condition of heart failure as established by the reports (Ugil et al., 2019).  The comorbidities together with the age of the patient can fasten up the heart failure condition. Another reason can be frailty which has been found to be related to the condition of heart failure as per the reports. The outcome of the said condition includes restrictions in the living pattern, precautionary measure, economic burden, long hospital stays and in chronic situations death. 

The ECG of the patient revealed that the heart beats are irregular and the exact rate was found to be 100 beats per minute which is quite high than the normal range which indicated towards the condition of tachycardia. The p waves are not disturbed but the ST segment was found to be depolarized which confirms that the patient have had the medical condition of heart failure and accounts for the chronic chest pain as well as shortness of breath.

Mr Deep was found to be experiencing the condition of shortness of breath which happens in the condition when the heart s not able to pump the required amount of blood to meet the demands of the body and due to this, the blood backs up and because of this, fluid buildup takes place in the lungs which causes the legs to swell and the person starts becoming pale due to the lack of the oxygenated blood flow (Buhumaid et al., 2019). The fluid in the lung makes the person short of breath (Riley & Beattie, 2017). The patient in the present case study has been taking Lasix tab which is used for the treatment of the fluid retention in the lungs and the congestion which the said retention causes in the heart (Dahiya et al., 2020). The patient has the habit of skipping out on the medicine which has been stated by him which can be accounted for the occurrence of the heart failure of the patient. Second reason can be the intake of high sodium content food which he had taken was soup which is a poison for a patient with hypertension and add up to the risk factor for heart failure.

Mr Deep had taken Viagra approximately six hours ago before the sudden onset of the chest pain because of the heart failure. The said medicine is to be taken with correct information because this rug has a tendency to interact with the other drugs and can lead to serious complications. There are reports which says that Viagra exacerbate heart failure condition in patients. Glyceryl trinitrate is another drug which is given to the patients with heart failure cases to help the in the relaxation process of the vascular muscles and reduce the systole. The said action is prevented by the former drug. The interaction between the drugs leads to the rise in the blood pressure thereby adding up to the increasing risks of heart failure of the patient. The holding back of such important information by the patient can be attributed to the shame as well as the careless nature.         

Generic name	Atenolol	Furosemide oral
Drug group	Beta blocker	Diuretics
Mechanism of action	The mechanism of ction of the said beta blocker revolves arund the binding capacity of the drug to the beta-1 adrenergic receptor in the areas of vascular smooth muscle of the heart. It then acts by clocking the positive ionotropic as well as the chronotropic actions of the enzymes known as epinephrine ad norepinephrine, both of which belong to catecholamines. The said action of the drug reduces the readings of the blood pressure and releasing the extra pressure from it (Rehman et al., 2020).	The said diuretic works by blocking the absorption of sodium as well as chloride from the kidney tubules and reduces the urine output of the patient. the oral administration is suitable for the condition of the concerned patient.
Side effects	Sleep problems, dzziness, fatigue, constipation, bradycardia and syncope.	Headache, hearing issues, tinnitus, vertigo and glycosuria.
Nursing considerations	Strict monitoring of blood pressure and diabetes.	Fluid output to be monitored and the level of sodium as well.

Medication adherence or the way of taking medications in a correct manner can be defined as the extent to which the patient is taking the medicine in the way as prescribed the by the doctors. The said action is important for the control of the chronic conditions as prevalent in this case. Mr Deep does wants to take frosemide because of its side effects. The side effects of the medicine can be accounted for one of the reason for the non-adherence factor for the patient as this will lead to the rise of complications (Van der Laan et al., 2017).  Too many medications for an individual also lead to the non-adherence of the medication as pre the reports (Ali et al., 2017). Lastly, cost an also be the reason for the non-adherence factor of the medications which is one of the most important factor with respect to the skipping out on the medicines (Beer et al., 2019).

Conclusion

The present case study of Mr Deep Sindhu, as described above, had a heart failure for which he got admitted in the hospital. The progression, outcomes and pathophysiology of the disease have been discussed. The pharmacology of the medicines has also been discussed. The risk factors which could add up to the emergent situation of heart failure has been given. The age of the patient also played a very important role for the said medical condition. A need for large scale of awareness program is required to prevent such condition from developing.

References

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