Heart Disease Annotated Bibliography

Heart Disease
Heart Disease

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Heart Disease Annotated Bibliography

Anand, S.S., Islam , S., and Rosengreen, A., (2008). Risk factors for myocardial infarction in women and men : insights from the interheart study. European heart journal . 29 (7), 932-940.

The article is about Coronary heart disease (CHD) which has been described as being amongst the leading cause of death amongst adults worldwide. Women have been found to be developing CHD about ten years after it has developed in men, but there are no clear reasons why this is so.  The authors aimed at establishing if disparities in the distribution of risk factors are found amongst men and women across various categories of ages in order to assist in explaining the reasons for women developing acute MI several years after men have developed it. 

The authors found out that on average most women develop their initial acute MI at least 9 years after men have developed it.  There were nine variable risk factors that were found to be critically related to acute MI in both genders. This was used in explaining more than 90% of the PAR.  There are disparities in age if the initial MI is narrated by the high degree of risk factors in men and young ages in comparison to women.  Compared to other articles this article was more informative in nature for it explained the reasons for lower incidents of CHD in women before the age of 50 years.  

It also explained that after this age CHD tends to increase with strategies that are usually seen in men in the eighth decade.  However, as much as the Framingham study defined risk factors that impact CHD in women it was limited to only White Caucasians residing in America. It was thus not able to explain the future age of the initial occurrence of myocardial infarction (MI) amongst women in relation to men. This source was thus very useful.

Heart Disease Annotated Bibliography

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Bray G.A. (2013) Risks of obesity. Endocrinology Metabolism Clinics of North America, 32 (4), 787-804.

According to the authors of this article even though obesity leads to an increase of lots of chronic diseases it is not all obese people that develop these diseases. In the recent past a subset of individuals who were obese got free of chronic diseases. The metabolic problems that have been perceived as the causes of these diseases were pointed out in the research literature.

The population is typified by intense insulin sensitivity, ordinary blood pressure and good levels of cholesterol in spite of excess adiposity.  It is now referred to as metabolic health obese.  The authors indicate that there has been a rapid interest to point out fresh insights in the processes of chronic diseases. The objective of this article is thus to translate outcomes into treatment alternatives. 

The disparity it has with other articles on this subject matter is the fact that it does not make a clear indication of whether Individuals that are MHO have been protected from the chronic diseases adverse effects as well as the mortality characteristic of obesity. Numerous longitudinal studies on the development of chronic diseases in MHO individuals have not exhibited any increased risk of the disease.

For instance St Pierra et al. followed 1800 men from Canada for a decade and a half and found that they were not at risk of heart diseases because they had MHO.A number of findings portray protection while other researchers have found out that MHO represents an impediment in the progression of diseases in subpopulations. Answers to these queries would provide critical implications for the policy on public health; however there is a lot of equivocalness in the existing literature. In spite of these findings the article was very useful.

Harris, T.B. (2007), carrying the burden of Cardiovascular risk in old age: Associations of weight and weight change with prevalent cardiovascular disease, risk factors and health status in the cardiovascular study. American journal of clinical Nutrition, 66 (3), 837-844.

As obesity and overweight rates rapidly increase in the US and globally the disease burden is becoming considerable and is likely to decrease life expectancy.  As much as obesity has rapidly been related to augmented risks of cardiovascular diseases (CVD) few research studies have assessed whether the deliberation of permanent change in BMI could offer extra information on CVD prediction.  Previous observational studies support the notion that the lowest CVD risk could be amongst those that have a stable weight.

The loss and gain of weight are related to poorer status of health and an increased rate of CVD mortality. In the assessment of BMI change there is a need for observational studies to be cautious so as to reduce confounding factors for instance likely underlying malignancy, smoking status and physical activity. The aim of this study was to employ potential data from a wide cohort with permanent follow up to effectively comprehend how BMI change is related to CVD risk. 

It also aims at finding out if the BMI trajectory consideration can add analytical information beyond the existing BMI knowledge. The study thus assessed   how BMI change in the past eight years was related to the main CVD events risk amongst 13,000 healthy men for 13 years. A rising and higher BMI were related to an increased CVD risk, however, increased BMI did not increase analytical information upon considering the existing BMI. Contrastingly, a decline in BMI was linked to an augmented CVD risk that was autonomous of the existing BMI. The article was thus very useful.

Heart Disease Annotated Bibliography

Bibliography

 Anand, S.S., Islam , S., and Rosengreen, A., (2008). Risk factors for myocardial infarction in women and men : insights from the interheart study. European heart journal . 29 (7), 932-940.

Bray G.A. (2013) Risks of obesity. Endocrinology Metabolism Clinics of North America, 32 (4), 787-804.

Harris, T.B. (2007), carrying the burden of Cardiovascular risk in old age: Associations of weight and weight change with prevalent cardiovascular disease, risk factors and health status in the cardiovascular study. American journal of clinical Nutrition, 66 (3), 837-844.

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Death of the Heart muscle

Heart muscle
Heart muscle

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Death of the Heart muscle

Question for discussion

Mr. Smith was lifting a heavy piece of furniture when he experienced crushing pain in his chest, began sweating heavily, and was nauseated. His wife drove him to the hospital, where he was diagnosed with a myocardial infarction (MI, also called a heart attack) and given intravenous drugs to dissolve a clot that was obstructing a major coronary artery. After his hospitalization, Mr. Smith?s doctor told him that some of his heart muscle had died. Explain the Pathological processes associated with the death of the heart muscle

Pathological processes associated with the death of the heart muscle

The function of heart relies on a complex network of cells’ ‘the cardiomyocytes for its appropriate function. These cells are the contracting cells in the heart, that exist in a three dimensional network of endothelial cells, vascular smooth muscle, an abundant fibroblasts and transient populations of immune cells. Gap junctions electrochemically coordinate the contraction of the individual cardiomyocytes, and their contraction to the extracellular matrix that transduces force and coordinates the overall contraction of the heart. In the cells, the repeating units of actin, as well as the myosin form the sarcomere structure, the basic functional unit of the cardiomyocyte.

The sarcomere has more than 20 proteins form connections between extracellular matrix and myocytes that regulate muscle contraction. The dysfunction occurs due to the disruption in the interaction in the complex activity that exist between multimeric complexes and many proteins. The heart can tolerate a variety of pathological insults, even then if the  adoptive responses that aim to maintain functions eventually fail, they result in a range of functional deficits of cardiomyopathy. (Pamela and Leslie,2011).

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Patho-physiological processes of cell injury

Tissue injury and cell death occur due to ischemic insult, is determined by the magnitude and duration of the blood supply and the changer induced due to reperfusion.   Prolonged ischemia, reduces  the ATP levels and intracellular PHdue to anaerobic metabolism and accumulation of lactate. This results in the dysfunction of ATPase dependent ion transport mechanisms, that contribute to increasing intracellular mitochondrial calcium levels, swelling of the cell and  the rupture of the cell, ultimately resulting in the death of the cell by necrotic, necroptotic. Apoptopic and autophagic mechanisms. (Theodore et.al,2012).

Reversible and irreversible cell injury

Reversible cell injury

Reversible cell injury denotes pathological changes that can be reversed, provided the stimulus is removed and the cellular injury is mild. Cellular injury can be recovered only to a certain point.(Farber et.al,1981)

Irreversible cell injury

Irreversible cell injury is a pathological change that is permanent and can cause cell death and cannot be reversed to normal state.(Farber et.al,1981)

Sustaining heart attack

The  cell injury causes loss of phosphorylation in mitochondria, increase in anaerobic glycolysis, slowing down of the pumping of sodium, failure of active transport. The morphological changes that include swelling of the cell, loss of microvilli and blebs. All these abnormalities can be reversible if the oxygenation is restored.

References

  1. Pamela A. Harvey and Leslie A. Leinwand (2011) Cellular mechanisms of cardiomyopathy, Journal of cell Biologyh,  vol. 194 no. 3 355-365 

2.      Theodore KalogerisChristopher P. BainesMaike Krenz, and Ronald J. Korthuis(2012). Cell Biology of Ischemia/Reperfusion Injury, Int Rev Cell Mol Biol. 2012; 298: 229–317.

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Comprehensive Heart Failure SOAP Note

Comprehensive Heart Failure
Comprehensive Heart Failure

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Comprehensive Heart Failure SOAP Note

Patient Initials: ______Mrs S. H._             Age: _57 Years______                               Gender: __ Female_____

SUBJECTIVE DATA: \

Chief Complaint (CC): “I have been experiencing shortness of breath and fatigue in the last two weeks.”

History of Present Illness (HPI):  Patient complains of shortness of breath, and general fatigue. Patient has been experiencing swelling of the feet and has been having difficulty in completing tasks that she would normally.

Medications: Synthroid 100mcg daily, Lisinopril 10 mg daily and Metoprolol 25 mg daily

Allergies: None

Past Medical History (PMH): measles at age 3, mumps at age 4

Past Surgical History (PSH): None

Family history;

Father died at age 65 y/o due to CAD.

Mother 70 y/o, alive diagnosed with hypertension

Brother (35) alive and healthy

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Personal and Social History:

 She is born and raised in this community. She is a college graduate with a diploma in business management. She works as an assistant in one of healthcare facilities within the community.  She lives with her daughter. She interacts with the community members. Pt denies smoking, but takes a lot of salt. The pt takes two cups of caffeine.  Pt states that she is physically inactive.

Review of Systems:

HEENT: EOMI, PERRL,

CV: RRR, S3 present, m/r/g absent

RESP: breathing symmetrical, SOB, CTAB x mild crackles

ABD- NABS, Palpable masses absent, s/nt/nd, HSMeg absent

MS: 5/5 strength

NEURO: Normal sensation to stimuli, normal gait, DTRs 2/4, Patellar and brachiorad

PSYCH: Congruent mood and appropriate

OBJECTIVE DATA:

t 98.9, HR 87, RR15, BP 114/69 Height 5’3 , weight  270ibs BMI  47.8

Gen: A&O X 3

HEENT: EOMI, PERRL,

CV: RRR, S3 present, m/r/g absent

RESP: breathing symmetrical, SOB, CTAB x mild crackles

ABD- NABS, Palpable masses absent, s/nt/nd, HSMeg absent

MS: 5/5 strength

NEURO: Normal sensation to stimuli, normal gait, DTRs 2/4, Patellar and brachiorad

PSYCH: Congruent mood and appropriate

 Labs: CBC, BMP

Imaging: CT

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ASSESSMENT:

Differential diagnosis (Dains, Bauman, and Scheibel, 2012):

a) Congestive heart failure

 Due to elevated blood pressure, swelling of the extremities and shortness of

b) Asthma

  Due to shortness of breathe, but not likely because patient denies history of asthma.

c)  COPD exacerbation

  Due to shortness of breath and general body weakness, but not likely because patient does not complain of productive cough.  

d) Pneumonia

 Due to shortness of breath and general body weakness, but not likely because patient denies chills, fever or coughs.  

 Final diagnoses: Congestive heart failure

 This is because the patient experiences edema, and dyspnea and shortness of breath.

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Plan:

Therapeutic intervention

Simvastatin 20 mg once a day

Lisinopril 25 mg once daily -continue
Metformin 1000 mg two times a day
Metoprolol 25 mg once a day

Loratadine 10mg one times daily

Glimepiride 4 mg one times daily
Follow up in two weeks

Non therapeutic interventions 

Lifestyle modification – reduced sodium chloride intake, caffeinated drinks, alcohol, clean eating, and physical activeness

Health promotion

Mammogram

Cervical screening test

Health prevention

 Healthy dietary is recommended to boost the immune system

Maintain hygiene to protect themselves from communicable diseases.

Reflections

  Congestive heart failure (CHF) is the leading cause for hospitalization in this community. There is no cure of the disease, but can effectively be managed through therapeutic and non-pharmacological measures (Esposito, Bagchi, and Verdier, 2009).  My preceptor and I were on the same page in during care delivery and treatment of this pt.  From the comprehensive assessment, I learnt that the patient was non-compliant to medication.I was assigned to research on the strategic ways that would be used to educate the patient and to ensure that she adhered to the recommended medication (Bickley, 2013

References ‘

Bickley, I.S. (2013). Bates Guide to physical examination and history taking .Wolters Kluwer/Lippincott Williams&Wilkins.

Esposito, D.,  Bagchi, A., Verdier,  J.M. (2009).  Medicaid beneficiaries with congestive heart failure: Association of medication adherence with healthcare use and costs. The American journal of managed care 15(7); 437-445

Dains, J.E., Bauman, L.C., Scheibel, P. (2012). Advanced Health Assessment and Clinical Diagnosis in Primary Care.

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