Module 2 Assignment: Case Study Analysis

The case study involves a 45-year-old woman who presents a chief complaint of a 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. The patient has a history of chronic obstructive pulmonary disease (COPD) with chronic cough. However, she states that the cough has gotten much worse and is interfering with her sleep. Other symptoms of the disease’s manifestation include thicker sputum that is harder for her to expectorate. The presence of these symptoms and the CXR confirm the presence of chronic obstructive pulmonary disease (COPD). According to Sarkar et al. (2019), COPD patients develop hyperinflation due to expiratory flow limitations caused by increased airway resistance and reduced lungs elastic recoil. Hyperinflation is responsible for various signs, including hyper resonance and flattened diaphragm.

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The Cardiovascular and Cardiopulmonary Pathophysiological Processes that Result in the Patient Presenting These Symptoms

Chronic obstructive pulmonary disease (COPD) covers two conditions with different pathophysiology: emphysema and chronic bronchitis. The pathophysiology of emphysema entails the decreased pulmonary elastic recoil exacerbated by damage to the airways distal to the terminal bronchiole, including respiratory bronchiole, alveolar sacs, alveolar ducts, and alveoli (McCance & Huether, 2019). On the other hand, chronic bronchitis manifests through the overproduction and hypersecretion of mucus by the goblet cells (Widysanto & Mathew, 2022). The risk factors for emphysema and chronic bronchitis are smoking, exposure to dust and chemicals, genetics, and the presence of asthma.

Although emphysema and chronic bronchitis lead to alternations of the respiratory system’s anatomy, COPD progression results in cardiovascular and cardiopulmonary issues, exacerbating cardiovascular diseases such as stroke and heart failure. According to Andre et al. (2019), a higher frequency of COPD exacerbations leads to increased incidences of myocardial infarction. In this sense, the interaction of the pathophysiologic process of the respiratory, cardiac, and vascular systems in people with COPD and CVD share various biomarkers, including c-reactive protein, fibrinogen, Brain-type Natriuretic peptide (BNP), and N-terminal proBNP (NT-proBNP), and Troponin. Equally, the pro-inflammatory environment in COPD patients can lead to pulmonary hypertension, elevated right ventricular filling pressure, and raised intrathoracic pressure responsible for higher incidences of atrial arrhythmias.

Any Racial/Ethnic Variables that May Impact Physiological Functioning

Firstly, the patient has a history of COPD, indicating previous exposures to risk factors such as passive and active smoking, exposure to dust and chemicals, and occupational exposure to pollutants. However, it is essential to consider the ethnic risk factors for COPD. Ethnicity entails aspects such as racial backgrounds. As a result, it is vital to interpret ethnic variables from the lens of genetic predisposition to COPD. According to Hall et al. (2018), alpha-1-antitrypsin (A1AT) can increase individual susceptibility to emphysema. In this sense, an inherited mutation in the 1 antitrypsin gene can result in the development of COPD at an early age among non-smokers.

How These Processes Interact to Affect the Patient

The interplay between cardiovascular and cardiopulmonary pathophysiological processes significantly affects patients with COPD. For instance, COPD leads to pulmonary parenchymal destruction and hypoxic vasoconstriction resulting in increased pulmonary vascular resistance. Other effects of progressive COPD include right ventricle dilation and hypertrophy, septum displacement to the right ventricle, and hypoxia (Hall et al., 2018). As a result, chronic obstructive pulmonary disease increases individual susceptibility to cardiovascular conditions like heart failure and stroke. In turn, this factor is responsible for increased mortality and morbidity.

References

André, S., Conde, B., Fragoso, E., Boléo-Tomé, J. P., Areias, V., & Cardoso, J. (2019). COPD and cardiovascular disease. Pulmonology, 25(3), 168–176. https://doi.org/10.1016/j.pulmoe.2018.09.006

Hall, R., Hall, I. P., & Sayers, I. (2018). Genetic risk factors for the development of pulmonary disease identified by genome-wide association. Respirology, 24(3), 204–214. https://doi.org/10.1111/resp.13436

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India, 36(1), 38. https://doi.org/10.4103/lungindia.lungindia_145_18

Widysanto, A., & Mathew, G. (2022). Chronic bronchitis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482437/