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XI. PATHOPHYSIOLOGY Medical Diagnosis

Angina Pectoris, Unstable; Diabetes mellitus t !e " # !oorl controlle$; Obesit ; HP% "; H !ertensi&e 'ar$io&ascular Disease(H')D*; Le+t )entricular H !ertro!, (L)H*; An-iet Disor$er

Definition
Angina Pectoris, Unstable - Unstable angina occurs when the narrowing becomes so severe that not enough blood gets through to keep the heart functioning normally, even at rest. The atherosclerotic plaque may rupture in unstable angina, allowing blood clots to precipitate and further decrease the lumen of the coronary vessel. This explains why an unstable angina appears to be independent of activity. Sometimes the artery can become almost completely blocked. t may occur unpredictably at rest which may be a serious indicator of an impending heart attack. Diabetes .ellitus t !e II - occurs when the pancreas produces insufficient amounts of the hormone insulin and!or the body"s tissues become resistant to normal or even high levels of insulin. H !ertensi&e 'ar$io&ascular Disease (H')D* - also known as hypertensive heart disease occurs due to the complication of hypertension or high blood pressure. n this condition the workload of the heart is increased manifold and with time this causes the heart muscles to thicken. The heart continues pumping blood against this increased pressure and over a period of time the left ventricle of the heart enlarges and this in turn causes the blood pumped by heart to reduce. Le+t )entricular H !ertro!, (L)H* - #eft ventricular hypertrophy $#%&' is the thickening of the myocardium $muscle' of the left ventricle of the heart caused by increased afterload and hypertension. H !ertension II- &ypertension is a chronic medical condition in which the blood pressure is elevated. Obesit - is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy. (ody mass index $() ', which compares weight and height, is used to define a person as overweight $preobese' when their () is between *+ kg!m* and ,- kg!m* and obese when it is greater than ,- kg!m*. $http.!!en.wikipedia.org!wiki!/besity' An-iet Disor$er # The anxiety disorders are a group of mental disturbances characteri0ed by anxiety as a central or core symptom. 1nxiety is associated with a wide range of physical illnesses, medication side effects, and other psychiatric disorders.

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Schematic Diagram
Pre$is!osing 1ge- 2, years old &ereditary- &34, 5) 6ender- female &x of 7holecystectomy $4))78 9::+' )enopause $starts at age ;* years old8 )enarche starts at age 9, yrs.old.' 5) $9:::8 usual glucose level. 9;--9<-mg!d#8 highest level. ,--mg!d#' Preci!itating =&34 $,2 yrs old8 usual (3 9;-!:-8 highest (3 is *--!99-mm&g' = nc. serum 7holesterol level. *,9mg!d# =#ack of exercise!activity =/besity $() of *2 kg!m*, (>. ;?.:<kg'

Increase shearing force of the arterial wall by the condition of the blood Nonspecific injury to arterial wall (endothelial injury) in the coronary artery

Diagnostic* -=-* 4osinophils.065;?(0500. 6500) Diagnostic* =lood -he istry* -holesterol.230 g"dl (0.200 g"dl) >riglycerides.090 g"d$ (0.0:0 g"dl) $D$.0:9 g"dl (0.0:0 g"dl) !edication* +,tor&astatin -alciu ($ipitor). /0 g 0 tab 'D 1 23 (,ntilipide ics) +4no(aparine 3odiu ($o&eno(). o56 l 3- q02 (,ntilipe ics) +,spirin (,spilet 4-)./0 g 0tab od (Nonopioid analgesics and antipyretics7 antiplatelet) +-lopidogrel (8late(an) 9: g"tab# ;tabs now# then 'D (,denosine diphosphate (,D8) receptor antagonist

Desqua ation of endothelial lining and sti ulation of !ast cells to produce infla

ation

Increase per eability"adhesion olecules# $ipids ($D$# %$D$) and acti&ation of platelets assi ilation into the area '(idi)ed $D$ attracts onocytes and acrophages to the site and plaques begin to for fro cells and s ooth uscle cells de&elop to for foa cells into thro bus

Diagnostic* +@.<ay <eport (-hest ,8. 3itting) I pressions* !edication* ,therosclerosis thoracic aorta5 <upture of atherosclerotic plaque (cap) and +, lodipine =esylate (Nor&asc).:0 g + -olor Doppler.channel blocFers7 Increase adhesion of these olecules and 0 tab Alow 'D (-alciu -onclusion* ,ntianginals) increase thro bus"blood clot for ation a) 3eg ental wall >rinitrate). otion abnor ality +Nitroglycerin (Hlyceryl indicati&e of coronary artery disease 3igns" sy pto s* 00 g 8atch (Nitrates"%asodilators7 3igns" b) ,ortic and itral scleroses5 <ightI left subcostal argin ,ntianginals) sy pto s* c) ,ortic regurgitation# -oronary Ische ia and Ische ia of chest pain.:.6"00 pain scale7 +Isosorbide !ononitrate (I 0B dur) +-old# -la y Diagnostic* regurgitation# tri&ial pain occur e&en during tissue in the region suppliedsFin by the 30d)g 0 !itral tab 'D (Nitrates"%asodilators7 Inter&entions* e(ertion or at rest7 +4-H tracing* !edication* ,ntianginals) Diagnostic* artery 'cclusion and stenosis"narrowing of the coronary +prolonged"dec +'btained a 02 lead 4-H and as prescribed 3>.depression I + !etoprolol >artrate 3igns" ptoistry* s* hea&iness tightness of +,spirin(,spilet 4-) /0 g 0tab od -linicalsy -he artery and leads to coronary &asoconstriction reased capillary 3igns" +,d inistered '2 inhalation &ia nasal > wa&e in&ersion (>oprol.@$) :0 g 0tab +decreased-alciu capillary/53 refill of : secs chest with dyspnea7 pain (Nonopioid analgesics) Decreased refill of : in the Diagnostic* 3igns" sy pto s* sy pto s* cannula at 2$" radiates in =ID (beta.adrenergic Increase de and +-linical for o(ygen and glucose tissues and +<<* up to the necF and Inter&entions* +Dia)epa (%aliu ).: g 0 tab =ID g"dl 26 cp 7 tachypneic seconds Inter&entions* 3igns" 3igns" sy pto s* -linical -he Dysrhyth istry* ias(bradycardia7 +Dugular &ein +,d&ised to perfor deep breathing -he istry* blocFers# leads to di inished yocardial o(ygenation# -ellular hypo(ia +dyspnea chin7 etabolis guarding beha&ior# ulation of sy pathetic 8eripheral ,naerobic caused by +'2ner&ous therapy &ia nasal cannula (,n(iolytics) (/5; C 0052 3ti g"dl) =8 ,nti.dysrhyth Inter&entions* +'2 therapy &ia sy pto +tachycardia7 Grea 8<*;9.:9bp g"dl ics) 7 tachycardia7 distention (D%D) e(ercises and $actic used of pursed.lip breathing 2ypoFale ia+increased 350 of Decreased Increase release norepinephrine ,ltered the nitrogen.22 +use of accessory uscles to of s* Increase Increase facial ,cid gri ace7 production tachycarsia at 2$" edulla in and altered cell e repolari)ation brane integrity + !etoprolol >artrate (>oprol.@$) syste o(ygen to sti ulate adrenal &asoconstriction and increased de and for '2 I with of N8' nasal cannula at +bradycardia7 8<*030.0:0bp (9.09 8< 030.0:0bp )7 palpitations73ti ulation Increased at /c (3ept5;.:#2009) noted technique o$"$that can lead +3pironoloctone(,ldacton of cardiac sensory ner&e endings to -ardiac and epinephrine yocardiu to g"d$) breathe needs of 030.0:0bp 7 ild Gnstable ,ngina 8ectoris :0 g 0tab =ID (beta.adrenergic Finins# potassiu ions# prostaglandins decreased blood flow to glucose in the tissues"hypo(ia 090"000 2g e(cept 85' eds 2$" in 8<* ;9.:9bp +palpitations di))iness + aintained rela(ing en&iron ent and (35:. :50 o$"$) e) 2: g 0tab 'D Decreased yocardial preload trans it to the central ner&ous to cause +nasal flaring an(iety7 syste body weaFness 'utput decreased cardiac output blocFers) the Fidneys +4le&ated 2'= Decreased Increased 2eart Increased after (8otassiu 3paring contractility left &entricular pain position of co fort ,therosclerosis

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!edication* +$osartan 8otassiu (-o)aar). 000 g 0tab 'D (,ngiotensin II antagonists) +-aptopril(-apoten).2: g J tab =ID (,ngiotensin II antagonists)

<enin (released fro Fidneys) to split off angiotensinogen to for angiotensin I ,ngiotensin.con&erting en)y e (,-4) re o&es and con&erts ,ngiotensin I into ,ngiotensin II which pro otes ,ntidiuretic hor one released &asoconstriction fro hypothala us to increase reabsorption of water by Fidneys to increased blood &olu e

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!edication* +3pironoloctone (,ldactone) 2: g 0 tab 'D (Distal >ubule Diuretics" 8otassiu 3paring Diuretics)

,ngiotensin II sti ulates adrenal corte( release aldosterone

3odiu retention by Fidneys and pro otes an increased plas a os otic pressure

-onstipation prior to ad ission (resol&ed 3ept 0#2009)

!edication* 3e a cone (3enoFot).30 l 'D 8' $actulose (-hephulac).30 l od 8' Diarrhea C resol&ed (3ept5 3# 2009)

Increased blood pressure

'&erloading of blood in the &entricles of the heart

Inter&entions* 2old la(ati&es for =!K 2(day as indicated

3igns" sy pto s* +=8.090"000 2g(hypertensi&e) +te p.365/E+Di))iness(00 days prior to ad ission until assess ent day +faintness(00days prior to ad ission) +blurred &ision

4(cessi&e stretch and decreased contraction occur

Increase worFload of the heart COMPLICATIONS: !yocardial Infarction Dysrhyth ias -ardiogenic shocF 8ul onary e bolis <ecurrent !yocardial Infarction %entricular aneurys s <upture of the heart 8ericarditis Death

Diagnostic* +4chocardiography -onclusion* -oncentric left &entricular hypertrophy with left &entricular diastolic dysfunction

>hicFening of the cardiac uscle that leads to $eft %entricular 2ypertrophy

2ypertensi&e -ardio&ascular Disease (2-%D)