Heart Failure Pathophysiology

Introduction

Diabetes is one of the most common metabolic disorders in the world. Its development is largely defined by multiple environmental and genetic factors. However, unhealthy lifestyle patterns such as a poor diet and the lack of physical activity contribute to the progression of diabetes the most. When not controlled well, the given metabolic disorder leads to many other adverse conditions including hypertension, chronic bronchitis, et cetera. The case of M.K., a 45-year-old female with a history of diabetes, depicts this situation.

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Diabetes and Health Risks

Glycated hemoglobin (HbA1c) is an important value associated with diabetes and its progression. Hemoglobin is a protein that can be found in the blood of every person. It delivers oxygen from the lungs to all the cells in the body. This protein may react with glucose. As a result of such a reaction, HbA1c is formed. However, when glycated, hemoglobin loses its ability to transport oxygen properly.

Overall, as a clinical parameter, HbA1c shows the mean blood sugar levels. Normally, HbA1c should not be higher than 6%, while the value over 6.5% implies that the patient has diabetes. Moreover, in case the HbA1c value does not decrease three months after starting the diabetes intervention, it may indicate that the disease is poorly or inadequately managed.

A high level of triglycerides is a sign of poorly managed diabetes as well (Mayo Clinic, 2018). It is also worth noticing that the value of 1000 mg/dL may contribute to the development of acute pancreatitis. Along with this, increased levels of total cholesterol, and LDL cholesterol, in particular, as well as a decreased levels of HDL cholesterol in the blood, increase the risk for the development of multiple disorders including atherosclerosis and coronary heart disease (Goldberg, n.d.). Considering that M.K. is obese, the situation the risks can be even higher because, when combined with abnormal amounts of lipids in the blood, obesity promotes insulin resistance, as well as various lipid disorders. It means that a current misbalance in the patient’s lipid profile may contribute to the progression of diabetes and hypertension.

Hypertension

It is possible to say that M.K. is currently experiencing stage 2 of hypertension. According to Rubenfire (2017), it is diagnosed when blood pressure (BP) values reach ≥140 or ≥90 mm Hg. Lacruz et al. (2015) state that even slightly elevated BP values increase the risk of cardiovascular diseases and stroke. It is observed that the “prevalence of hypertension is greater in European countries compared with Northern American countries” (Lacruz et al., 2015, p. e952). However, the level of control and treatment of this condition in the United States is much lower than in Europe. It means that the US population is at higher risk of developing hypertension-associated co-morbidities.

Awareness of this condition and its early management through behavioral and pharmacological interventions are essential, and it is valid to say that M.K. is prescribed with an angiotensin-converting enzyme (Lotensin) and a diuretic (Lasix) because they help prevent adverse hypertension-related complications. For example, Lasix is meant to treat edema and eliminate retained fluids, which allows avoiding problems with kidneys, and other organs. At the same time, Lotensin lowers blood pressure “by inhibiting the formation of angiotensin II, thus relaxing the arteries” (“Benazepril,” n.d., para. 1). By doing so, the drug increases the pumping efficiency of the heart and, in this way, mitigates the risks of heart failure.

Chronic Bronchitis and Signs of Heart Failure

The patient has recently diagnosed with chronic bronchitis ̶ a progressive diffuse inflammation in bronchi, leading to morphological reorganization of the bronchial wall and peribronchial tissue. It usually occurs as a result of a long-term irritation of the bronchi (due to smoking, inhaling of dust, etc.), which leads to changes in their mucous membrane and facilitates the penetration of various pathogens. According to Meek et al. (2015), a productive morning cough is one of the most common symptoms of chronic bronchitis, and it occurs much more often than nighttime or a daytime cough and wheezing in patients with this condition. This symptom correlates with M. K.’s diagnosis. Additionally, she has a decreased level of oxygen and an elevated level of carbon dioxide in the blood which indicates that her body does not receive enough oxygen due to respiratory and some other problems.

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Such M.K.’s symptoms as distended neck veins, excessive peripheral edema, and increased urination at night may also signify the development of right-sided heart failure. It is observed that “in right-sided heart failure, the right ventricle loses its pumping function, and blood may back up into other areas of the body, producing congestion” (Air Physio, 2018, para. 2). Various lung diseases, including chronic bronchitis, may substantially contribute to its development. Nevertheless, the way these diseases trigger heart failure is not entirely clear. De Miguel Díez, Morgan, and García (2013) claim that it can happen due to vascular endothelial dysfunction, elevated inflammatory mediators, and accelerated atherosclerosis associated with chronic pulmonary diseases. These factors and inflammation, in particular, can consequently lead to left ventricular systolic dysfunction which, in turn, causes increased fluid pressure that damages the right side of the heart when this fluid pressure is transferred back through the lungs.

Recommendations

First of all, at the current stage, it can be recommended for M.K. to take regular inhalations in order to reduce the production of mucus and constriction of the bronchi (“Understanding chronic bronchitis,” n.d.). It will allow improving the condition of the mucosa, reduce the number of exacerbations, and significantly delay or completely avoid the development of respiratory failure. Additionally, it is important to eliminate factors that may contribute to the progression of bronchitis. Firstly, it implies a healthier lifestyle: the patient needs to quit smoking and engage in physical activity (“Understanding chronic bronchitis,” n.d.). Moreover, it is essential to get rid of the foci of chronic infections within the respiratory tract if there are any.

Additionally, the patient should take medications to decrease the cholesterol level. As Grandjean, Gordon, Davis, and Durstine (2013) state HMG-CoA reductase inhibitors (statins) are regarded as the most effective type of medication for cholesterol reduction. Statins lower the level of lipids by decreasing the synthesis of cholesterol in the liver. Moreover, they have an anti-inflammatory effect and protect vascular sites. These drugs can also reduce the incidence of atherosclerosis-related complications and the severity of vascular lesions. Nevertheless, their side effects can include damage to the liver and muscles. Therefore, when taking HMG-CoA reductase inhibitors, it is important to administer blood tests regularly to find any liver damage products promptly (Grandjean et al., 2013). Despite possible side effects, the intake of this cholesterol-reducing drug is highly recommended for M.K.

Conclusion

Overall, the evaluated lab values indicate that the patient does not manage her hypertension and diabetes properly: she might not take prescribed drugs regularly and does not change her behaviors in a way that would lead to improvements. As a result, her condition continues to turn worse, and the recent diagnosis of chronic bronchitis only verifies this assumption. Currently, she is also at high risk of developing heart failure, atherosclerosis, and coronary heart disease. The provided recommendations have the purpose of avoiding these risks. By following them, she can improve her health and the overall quality of life.

References

Air Physio. (2018). Right-sided heart failure. Web.

Benazepril. (n.d.). Web.

De Miguel Díez, J., Morgan, J. C., & García, R. J. (2013). The association between COPD and heart failure risk: A review. International Journal of Chronic Obstructive Pulmonary Disease, 8, 305-312.

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Goldberg, A. C. (n.d.). Overview of cholesterol and lipid disorders. Web.

Grandjean, P. W., Gordon, B., Davis, P. G., & Durstine, J. L. (2013). Hyperlipidemia and dyslipidemia. In J. K. Ehrman et al., (Eds.). Clinical exercise physiology (pp. 155-176). Champaign, IL: Human Kinetics.

Lacruz, M. E., Kluttig, A., Hartwig, S., Löer, M., Tiller, D., Greiser, K. H., … Haerting, J. (2015). Prevalence and incidence of hypertension in the general adult population: Results of the CARLA-cohort study. Medicine, 94(22), e952.

Mayo Clinic. (2018). Triglycerides: Why do they matter? Web.

Meek, P. M., Petersen, H., Washko, G. R., Diaz, A. A., Kim, V., Sood, A., & Tesfaigzi, Y. (2015). Chronic bronchitis is associated with worse symptoms and quality of life than chronic airflow obstruction. Chest, 148(2), 408-416.

Rubenfire, M. (2017). 2017 guideline for high blood pressure in adults. Web.

Understanding chronic bronchitis. (n.d.). Web.

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