COPD, Heart Failure, Hypertension and Diabetes Mellitus

Introduction

Addressing health problems associated with high blood pressure and diabetes mellitus, as a rule, involves analyzing patients’ lifestyles to identify specific habits and other factors that lead to such diseases. People with the aforementioned diagnoses are at risk as patients with a tendency to heart failure due to concomitant problems with blood flow, blood oxygen saturation, and other necessary processes. Associated problems, for instance, chronic bronchitis, can also be the result of poor lifestyle choices and bad habits. As an example, the case of M.K. will be reviewed, and appropriate justification will be given to her current state and body functions based the evaluation of the laboratory tests conducted. Elevated LDL and decreased HDL levels, significant triglyceride concentrations, and several other crucial parameters indicate high health risks and explain the patient’s current problems.

Treatment and Recommendations for M.K.’s Chronic Bronchitis

Diagnosing chronic bronchitis in M.K. is confirmed by laboratory tests that prove the prerequisites for the development of this disease. According to the clinical findings, her PaCO₂ level is 52 mm Hg. This indicator exceeds the norm significantly since, in a healthy person, the PaCO₂ level should not exceed 45 mm Hg. This parameter reflects the ability of the alveoli to ventilate air and get rid of excess carbon dioxide. An increased level confirms poor lung function and the stagnation of air. Another critical parameter that confirms the objectivity of the diagnosis of chronic bronchitis is a reduced PaO₂ indicator. Such a definition serves to determine the function of oxygen exchange in the lungs. In M.K., this indicator is 48 mm Hg, while in a healthy person, it should be at least 80. Stagnant oxygen irritates the lungs, which, in turn, causes coughing and leads to problems with blood circulation. As a result, the patient experiences discomfort in the chest area, and breathing is difficult.

As a treatment plan, the patient should take an expectorant that removes excess phlegm from the lungs and makes breathing easier. Cazzola et al. (2018) draw attention to erdosteine ​​as a drug that has a potentially strong effect on the causes of chronic bronchitis and helps normalize breathing. As the authors state, medications of the group to which erdosteine ​​belongs not only allow addressing the corresponding symptoms but also have antioxidant properties (Cazzola et al., 2018). This, in turn, is a useful property that makes it possible to inhibit oxidation and neutralize the negative effects of stagnant oxygen in the lungs. As an additional recommendation, quitting bad habits, particularly smoking, is a prerequisite for normalizing M.K.’s condition and achieving the success of the treatment plan. Since the patient has a history of smoking for approximately 22 years, her lungs are weakened by the harmful effects of combustion products. Quitting nicotine can help restore normal respiratory function and relieve the symptoms of chronic bronchitis.

Suspected Type of Heart Failure and Its Pathogenesis

While taking into account M.K.’s health indicators and her current problems, one can define her health condition as a background for the development of heart failure. According to Lehrke and Marx (2017), one of the prerequisites and risk factors is diagnosed diabetes that causes an increase in blood glucose levels and vascular problems. M.K.’s health indicators prove that she is in a vulnerable category of the population. Based on the clinical findings, her triglyceride level is 1000 mg/dL, which is twice the critical limit of normal. The patient is overweight, and the calculation shows that her BMI is 36.3, which corresponds to the second type of obesity. All these factors are prerequisites for the development of congestive heart failure. Given the accompanying symptoms, in particular, excessive peripheral edema, distended neck veins, and light-headedness, the risk of developing right-sided heart failure is high. The pathogenesis of this health problem and its features fit the general clinical picture of M.K., which is a significant factor that necessitates the adoption of preventive measures.

Heart failure is the weakening of the pumping function of the heart. According to Konstam et al. (2018), hypertension is often a prerequisite for heart failure. High blood pressure causes the heart to continually work harder, but it degrades due to the inability to function at a high rate on a regular basis. Based on M.K.’s symptoms, she is at risk of developing right-sided heart failure. The right side of the heart is responsible for returning low-oxygen blood back to the lungs, and in right-sided heart failure, the right ventricle does not work properly (Konstam et al., 2018). This causes increased pressure in the veins, displacing fluid into the surrounding tissues, and as a result, swelling, particularly in feet, toes, ankles, and lower legs. This can also lead to an urgent need to urinate at night when circulation in the kidneys is better. As a common cause, Konstam et al. (2018) cite an acute or chronic increase in resistance to pulmonary circulation. Thus, chronic bronchitis is evidence of M.K.’s impaired lung function.

Stage of Hypertension the Rationale for the Current Medications

One of the key manifestations of M.K.’s health problems is high blood pressure. Based on the results of the clinical tests, this figure is 158/98 mm Hg. This parameter indicates a significantly increased systolic and diastolic pressure. According to the American Heart Association (2017), this parameter allows confirming stage 2 hypertension when the systolic pressure exceeds 140 mm Hg, and the diastolic pressure exceeds 90 mm Hg. Risk factors include poor lifestyle choices, such as smoking and eating unhealthy food, concomitant type 2 diabetes, and problems with blood flow. As a medical treatment, the patient takes drugs to lower blood pressure. At the moment, she takes Lotensin and Lasix, which, as Davis and Oparil (2018) note, are classified as common antihypertensive drugs (Davis & Oparil, 2018). Lotensin and Lasix are angiotensin-converting enzyme inhibitor and diuretic, respectively. The purpose of each of them is due to the existing problems of the patient – the need to dilate blood vessels to normalize blood flow and remove excess fluid to prevent edema and heart stress. This course of drug treatment helps address the existing problems and prevent the worsening of the disease.

The risk of hypertension is a severe problem among the American population, and this fact is supported by the relevant research on the spread of the disease. Al Kibria et al. (2019) report the statistical results of a large-scale study conducted in collaboration with the American Heart Association. According to the authors, about 45% of the adult population is at risk of developing hypertension or diagnosed with this ailment (Al Kibria et al., 2019, p. 1631). For the M.K.’s age group, the average number of people from 35 to 49 with a confirmed diagnosis of hypertension is 50.4% (Al Kibria et al., 2019, p. 1631). Based on the existing data, this figure increases with age, which aggravates the health issue. In most patients, similar causes of the development of the disease are observed – high cholesterol, diabetes, kidney problems, obesity, and some other problems. Combating hypertension is an important aspect of the activities of the healthcare system, and work on eliminating the widespread prevalence of the ailment is crucial.

M.K.’ Risk Conditions and Additional Medications to Take

The lipid panel indicators obtained after performing relevant clinical tests prove the patient’s severe problems with the cholesterol level. HDL deficiency and significant LDL excess exacerbate M.K.’s current condition and are additional risk factors in the development of heart failure. Moreover, the patient’s triglycerides that are significantly higher than the norm confirm the threat of a large amount of adipose tissue in the M.K.’s body.

At the same time, these indicators can be the determinants of associated health problems. According to Lanktree et al. (2018), the parameters of HDL, LDL, and triglycerides can stimulate the development of such a dangerous ailment as chronic kidney disease (CKD). The authors cite the results of the study and note that high HDL cholesterol in patients improves kidney function, while low levels, conversely, impair their condition (Lanktree et al., 2018). Regarding medications recommended to M.K. as an adjunct treatment, calcium channel blockers and statin may be offered. As Lee et al. (2018) state, the drug of the first group allows addressing heart problems and normalizing the tone of the heart muscle. Statin, in turn, helps lower LDL cholesterol, which can have a positive effect on the patient’s health (Lee et al., 2018). These medications can complement the aforementioned treatment with Lotensin and Lasix.

The analysis of the lipid panel indicators suggests that the patient’s cholesterol data correlates with both stage 2 hypertension and type 2 diabetes mellitus. In their research, Lee et al. (2018) mention “body mass index (BMI), hypertension, diabetes mellitus,” and several other problems as confounding factors in the development of CKD (p. 2). An excessively high triglyceride parameter proves that the proportion of M.K.’s adipose tissue is large, which, in turn, aggravates the pressure on vessels and complicates the work of the pancreas responsible for insulin production. Thus, due to obesity and the inability of the body to excrete LDL in sufficient quantities, complications manifest themselves in impaired blood flow and poor metabolism leading to high blood pressure and blood glucose concentration.

Lab Value for HbA1c in Relation to the Patient’s Body Function

One of the indicators of M.K.’s clinical testing is the glycosylated hemoglobin level that is often mentioned as HbA1c. This parameter is the most important indicator of a biochemical nature and shows the level of sugar in the blood for a certain period. According to Vijayakumar et al. (2017), in general, this is a complex consisting of hemoglobin and glucose that are irreversibly combined, which is a sign of diabetes mellitus. By using the analysis for glycated hemoglobin, M.K. was diagnosed with this disease because the rate of HbA1c was 7.3%. In diabetes, the norm of glycated hemoglobin is slightly higher than for healthy people, and an indicator of up to 7% is allowed. If, as a result of the analysis, the indicator exceeds this threshold, diabetes is not compensated, which, in turn, may cause severe complications.

This analysis is effective for determining abnormalities in the body and monitoring the function of individual organs. As Boniol et al. (2017) argue, unlike normal blood sugar levels that often change with physical activity and food intake, glycated hemoglobin levels change slowly. In this regard, this indicator becomes a reliable criterion for the success of control and a chance to determine diabetes in the body at an early stage. Such a long-term analysis capability allows HbA1C to be used as an indicator of diabetes control because levels are scored, patients are informed about specific outcomes, and proper treatment courses are prescribed. In the case of M.K., the use of testing for HbA1c allows confirming adrenal abnormalities and elevated blood glucose levels, which entails the aforementioned consequences. The adequate monitoring of this indicator is a prerequisite for compiling the necessary treatment program prescribed for the patient.

Conclusion

The assessment of the case in question confirms that the health problems that M.K. experiences are the result of numerous problems, and the symptoms confirm the correctness of the diagnoses. The analysis of cholesterol levels, blood glucose, triglycerides, PaCO₂, PaO₂, and some other indicators makes it possible to substantiate the proposed treatment regimen and evaluate the associated problems. The risk of developing CKD is one of the most severe threats in the patient’s current state. Correlations between stage 2 hypertension and type 2 diabetes mellitus are reflected and presented in the context of laboratory tests. The patient’s lifestyle is a barrier to improving her well-being, and giving up bad habits and controlling nutrition are crucial recommendations.

References

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American Heart Association. (2017). Highlights form the 2017 guideline for the prevention, detection, evaluation and management of high blood pressure in adults. Web.

Boniol, M., Dragomir, M., Autier, P., & Boyle, P. (2017). Physical activity and change in fasting glucose and HbA1c: A quantitative meta-analysis of randomized trials. Acta Diabetologica, 54(11), 983-991. Web.

Cazzola, M., Calzetta, L., Page, C., Rogliani, P., & Matera, M. G. (2018). Impact of erdosteine on chronic bronchitis and COPD: A meta-analysis. Pulmonary Pharmacology & Therapeutics, 48, 185-194. Web.

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Konstam, M. A., Kiernan, M. S., Bernstein, D., Bozkurt, B., Jacob, M., Kapur, N. K., Kociol, R. B., Lewis, E. F., Mehra, M. R., Pagani, F. D., Raval, A. N., & Ward, C. (2018). Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation, 137(20), e578-e622. Web.

Lanktree, M. B., Thériault, S., Walsh, M., & Paré, G. (2018). HDL cholesterol, LDL cholesterol, and triglycerides as risk factors for CKD: A Mendelian randomization study. American Journal of Kidney Diseases, 71(2), 166-172. Web.

Lee, E. Y., Yang, Y., Kim, H. S., Cho, J. H., Yoon, K. H., Chung, W. S., Lee, S. H., & Chang, K. (2018). Effect of visit-to-visit LDL-, HDL-, and non-HDL-cholesterol variability on mortality and cardiovascular outcomes after percutaneous coronary intervention. Atherosclerosis, 279, 1-9. Web.

Lehrke, M., & Marx, N. (2017). Diabetes mellitus and heart failure. The American Journal of Cardiology, 120(1), S37-S47. Web.

Vijayakumar, P., Nelson, R. G., Hanson, R. L., Knowler, W. C., & Sinha, M. (2017). HbA1c and the prediction of type 2 diabetes in children and adults. Diabetes Care, 40(1), 16-21. Web.