A Case Study about

Cardiovascular Disease
(Hypertension)

Submitted by:
Abigail P. Basco
 PATIENT’S PROFILE

Name: Artemio T. Lungud

Age: 63 y/o

Sex: Male

Birth Date: June 24, 1955

Birth Place: District II Gamu Isabela

Religion: Roman Catholic

Civil Status: Married

Nationality: Filipino

Address: District II Gamu Isabela

Date of Admission: October 01, 2018

Chief Complaint: Blurring of vision

Clinical Diagnosis: Cardiovascular Disease ( hypertension)

Past History: Hypertension

Cardiovascular disease

Heart disease or cardiovascular disease are the class of diseases that involve the
heart or blood vessels (arteries and veins).While the term technically refers to any disease
that affects the cardiovascular system, it is usually used to refer to those related to
atherosclerosis (arterial disease). These conditions usually have similar causes,
mechanisms, and treatments.

Most countries face high and increasing rates of cardiovascular disease. Each
year, heart disease kills more Americans than cancer. In recent years, cardiovascular risk
in women has been increasing and has killed more women than breast cancer. A large
histological study (PDAY) showed vascular injury accumulates from adolescence, making
primary prevention efforts necessary from childhood.

By the time that heart problems are detected, the underlying cause
(atherosclerosis) is usually quite advanced, having progressed for decades. There is
therefore increased emphasis on preventing atherosclerosis by modifying risk factors,
such as healthy eating, exercise, and avoidance of smoking.

Population based studies show that the precursors of heart disease start in
adolescence. The process of atherosclerosis evolves over decades, and begins as early
as childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study
demonstrated that intimal lesions appear in all the aortas and more than half of the right
coronary arteries of youths aged 7–9 years. However, most adolescents are more
concerned about other risks such as HIV, accidents, and cancer than cardiovascular
disease.

This is extremely important considering that 1 in 3 people will die from

complications attributable to atherosclerosis. In order to stem the tide education and
awareness that cardiovascular disease poses the greatest threat and measures to
prevent or reverse this disease must be taken.

Obesity and diabetes mellitus are often linked to cardiovascular disease, as are a
history of chronic kidney disease and hypercholesterolaemia. In fact, cardiovascular
disease is the most life threatening of the diabetic complications and diabetics are two-
to four-fold more likely to die of cardiovascular-related causes than nondiabetics.

The Cardiovascular System consisting of heart and blood vessels, arteries,

arterioles, capillaries, venules, veins, sinuses and lymphatics). The circulatory system
transports respiratory gases, nutrients and waste products to various parts of the body.

LOCATION
Heart is a pumping organ of blood vascular system. It is located in the thorax
between the lungs and abdomen behind the sternum and its apex rests on the diaphragm.

STRUCTURE
The structure of heart resembles the closed fist. It is hollow, muscular, contractile
organ. The walls of heart possess three layers:

1. The outer layer known as epicardium composed of serous layer

2. The middle layer known as myocardium composed of cardiac muscle.
3. The inner layer known as endocardium which lines the four chambers of the heart and
also covers the valves.

The heart is also enclosed in a fibrous sac called as pericardium. The space between
pericardium and epicardium is known as pericardial cavity. This contains serous fluid that
has lubricating action and thus helps in free movement of the heart.
A septum divides the heart into right and left valves. These are further subdivided into
four chambers viz. Right auricle, right ventricle, left auricle and left ventricle. The auricle
(atria) is thin walled and serves as a receiving chamber for blood and are low pressure
pumps. The ventricles are thick walled and serve as high pressure pump. The two atria
open into the respective ventricles. These are guarded by an atrioventricular (AV) valve.
Right AV valve is called as tricuspid valve (three cusps) whereas left AV valve is called
as bicuspid valve (two cusps) or mitral valve. The atria and ventricle are completely
separated from each other in order to prevent the mixing of impure (deoxygenated blood)
and pure (oxygenated) blood.
Superior and inferior vena cava brings deoxygenated blood from the upper and lower part
of the body to the right atrium. This blood then enters the right ventricle through right AV
valve. The AV valve allows the blood to flow from the atria to respective ventricles but
prevents the back flow of blood. The walls of right ventricle are thinner than that of left
ventricle. This is due to the fact that right ventricle has to pump deoxygenated blood to
lungs only (which are very near) whereas, left ventricle has to pump oxygenated blood all
over the body. The deoxygenated blood from right ventricle then goes to lungs for
oxygenation through pulmonary artery. Pulmonary vein brings the oxygenated blood from
the lungs to the left atrium. This pure blood is then forced from the left atrium to left
ventricle through the left AV valve. The left ventricle opens in to aorta, which supply blood
to all other tissues and organs. The opening of ventricles into these great arteries
(pulmonary and aorta) is guarded by semilunar valves. These valves allow blood to enter
the great artery from the ventricle but prevent its back flow.
SYSTEMIC CIRCULATION
Systemic circulation is the flow of blood from the left ventricle through the aorta to all parts
of the body (except lungs) and back to the right atrium. The functions of systemic
circulation are to supply oxygen and nutrients to body tissues and to remove carbon
dioxide, heat and other waste material from the tissue. All systemic arteries branch from
the aorta, which arises from the left ventricle of the heart.
PULMONARY CIRCULATION
The flow of blood (impure) from the right ventricle of the heart to the lungs for purification
and return of the pure blood from the lungs to the left atrium is called as pulmonary
circulation. It is short circulation.
The pulmonary trunk arises from the left ventricle and divides into four
pulmonary arteries which carries blood in lungs (It is only this part of circulation where
an artery carries deoxygenated blood). Pulmonary veins bring back the oxygenated blood
from the lungs to the left atrium. (It is only this part of circulation where a vein carries
oxygenated blood).
The cardiovascular system can be thought of as the transport system of the body. This
system has three main components: the heart, the blood vessel and the blood itself. The
heart is the system's pump and the blood vessels are like the delivery routes. Blood can
be thought of as a fluid which contains the oxygen and nutrients the body needs and
carries the wastes which need to be removed. The following information describes the
structure and function of the heart and the cardiovascular system as a whole.

Structure and Function of the Heart

Function and Location of the Heart

The heart's job is to pump blood around the body. The heart is located in between the
two lungs. It lies left of the middle of the chest.
Structure of the Heart

The heart is a muscle about the size of a fist, and is roughly cone-shaped. It is about
12cm long, 9cm across the broadest point and about 6cm thick. The pericardium is a
fibrous covering which wraps around the whole heart. It holds the heart in place but allows
it to move as it beats. The wall of the heart itself is made up of a special type of muscle
called cardiac muscle.

Chambers of the Heart

The heart has two sides, the right side and the left side. The heart has four chambers.
The left and right side each have two chambers, a top chamber and a bottom chamber.
The two top chambers are known as the left and right atria (singular: atrium). The atria
receive blood from different sources. The left atrium receives blood from the lungs and
the right atrium receives blood from the rest of the body. The bottom two chambers are
known as the left and right ventricles. The ventricles pump blood out to different parts of
the body. The right ventricle pumps blood to the lungs while the left ventricle pumps out
blood to the rest of the body. The ventricles have much thicker walls than the atria which
allows them to perform more work by pumping out blood to the whole body.

Blood Vessels

Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from
the body back to the heart. Arteries are blood vessels which carry blood from the heart to
the body. There are also microscopic blood vessels which connect arteries and veins
together called capillaries. There are a few main blood vessels which connect to different
chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps
blood into the aorta which then carries it to the rest of the body through smaller arteries.
The pulmonary trunk is the large artery which the right ventricle pumps into. It splits
into pulmonary arteries which take the blood to the lungs. The pulmonary veins take
blood from the lungs to the left atrium. All the other veins in our body drain into the inferior
vena cava (IVC) or thesuperior vena cava (SVC). These two large veins then take the
blood from the rest of the body into the right atrium.

Valves

Valves are fibrous flaps of tissue found between the heart chambers and in the blood
vessels. They are rather like gates which prevent blood from flowing in the wrong
direction. They are found in a number of places. Valves between the atria and ventricles
are known as the right and left atrioventricular valves, otherwise known as the tricuspid
and mitral valves respectively. Valves between the ventricles and the great arteries are
known as the semilunar valves. Theaortic valve is found at the base of the aorta, while
the pulmonary valve is found the base of the pulmonary trunk. There are also many
valves found in veins throughout the body. However, there are no valves found in any of
the other arteries besides the aorta and pulmonary trunk.

What is the Cardiovascular System

The cardiovascular system refers to the heart, blood vessels and the blood. Blood
contains oxygen and other nutrients which your body needs to survive. The body takes
these essential nutrients from the blood. At the same time, the body dumps waste
products like carbon dioxide, back into the blood, so they can be removed. The main
function of the cardiovascular system is therefore to maintain blood flow to all parts of the
body, to allow it to survive. Veins deliver used blood from the body back to the heart.
Blood in the veins is low in oxygen (as it has been taken out by the body) and high in
carbon dioxide (as the body has unloaded it back into the blood). All the veins drain into
the superior and inferior vena cava which then drain into the right atrium. The right atrium
pumps blood into the right ventricle. Then the right ventricle pumps blood to the pulmonary
trunk, through the pulmonary arteries and into the lungs. In the lungs the blood picks up
oxygen that we breathe in and gets rid of carbon dioxide, which we breathe out. The blood
is becomes rich in oxygen which the body can use. From the lungs, blood drains into the
left atrium and is then pumped into the left ventricle. The left ventricle then pumps this
oxygen-rich blood out into the aorta which then distributes it to the rest of the body through
other arteries. The main arteries which branch off the aorta and take blood to specific
parts of the body are:

Carotid arteries, which take blood to the neck and head

Coronary arteries, which provide blood supply to the heart itself

Hepatic artery, which takes blood to the liver with branches going to the stomach

Mesenteric artery, which takes blood to the intestines

Renal arteries, which takes blood to the kidneys

Femoral arteries, which take blood to the legs

Treatment

People with stable angina are usually treated by tight control of cardiovascular risk factors
and by prescribing drugs (eg aspirin, beta-blockers, nitrates and long-acting calcium
channel blockers). When unstable angina develops, the risk of heart attack is very high
and rapid preventive treatment in an intensive or coronary care unit may be required.

People with diabetes who have experienced an acute heart attack benefit to the same
degree, and in some cases even more, from therapeutic interventions that are used in
people without diabetes.

Intensive insulin therapy for tight blood glucose control when the patient is in hospital has
also proven to decrease death rates, and may be beneficial for at least three months
following hospitalization. The DIGAMI Study from Sweden stresses the importance of
controlling blood glucose levels during the acute phase and demonstrates that intensive
insulin treatment also improves survival over the longer term, with a 24% reduction in
death rates after three and a half years. This means a saving of one life for every nine
patients on intensive insulin treatment. If people with diabetes require revascularization -
a procedure to either open up blocked blood vessels (angioplasty) or to bypass them
using implanted vessels from other parts of the body (bypass surgery) - bypass has
proven to be a judicious choice particularly when several coronary vessels are involved,
which is frequently the case in diabetes. The use of tiny metal devices called stents to
keep arteries open has also improved the prognosis of some patients with diabetes and
coronary heart disease.
Heart failure is a complication of coronary heart disease which occurs more frequently in
people with diabetes. It is usually treated with drugs such as 'water tablets' (diuretics),
ACE inhibitors, beta-blockers and digitalis

Treatment of Cerebrovascular Disease

As well as being a risk factor for stroke, diabetes and other high blood glucose conditions
have adverse effects on both the short and long-term prognosis for stroke victims.
Hyperglycaemia in the acute phase of stroke has been associated with high death rates,
regardless of the presence or absence of diabetes. Tight glucose control improves the
time of recovery.

The standard therapies of intervention in stroke in people without diabetes are also helpful
in people with diabetes. Indeed, the effect of aspirin on cardiovascular events in people
with diabetes has been suggested to be even stronger than in people without diabetes.

Resources need to be made available for the rehabilitation of stroke patients, which may
be particularly complicated in people with diabetes due to the presence of other
complications.

URINALYSIS

Characteristics Normal Result Indication Analysis

Values

Color Pale yellow to Dark Yellow Any changes in Dilute urine

deep amber urine color, or may appear
the presence of almost clear,
an abnormal or very pale
urine color that yellow.
cannot be
linked to the
consumption of
a food or drug.

Reaction 4.5-8pH 6.0 A pH value Based on the

greater than 7 result, it
is considered indicates
to be basic
normal ph
A pH value less because
than 7 is acidic normally, urine
is acidic

Specific gravity 1.010-1.025 1.030 Concentrated Slightly

urine has a increased
higher specific implies
gravity; diluted nephritic
urine has a syndrome
lower specific
gravity.
 RBC Normal values 0-2 Greater than There’s no
are 4 red blood normal RBC presence
cells per high numbers of red in the urine
blood cells in
power field
the urine may
(RBC/HPF) indicate:
 Acute
tubular
necrosis
 Cystitis
 Glomerulo
nephritis
Interstitial
nephritis

Pus cells 0 35-40 The presence The laboratory

of pus cells result shows
always presence of
indicates pus in the
infection. urine which
indicates
infection.

Amorphous few few Common Presence of

Urates- it is crystals seen amorphous
seen as yellow even in healthy urates in urine
to brown patients include specimen
aggregates of calcium proves little
small rounded oxalate, triple clinical value.
particles phosphate
crystals and
amorphous
phosphates.

Sugar o (-) No sugar There is no

presence of
sugar in the
urine.

DIAGNOSTIC PROCEDURE

Electrocardiography

Electrocardiography is the most commonly used test for evaluating cardiac

status, graphically records the electrical current (electrical potential) generated by the
heart. This current radiates from the heart in all directions and, on reaching the skin, is
measured by electrodes connected to an amplier and strip chart recorder. The standard
resting ECG uses five electrodes to measure the electrical potential from 12 different
leads; the standard limb leads (I,II,III), the augmented limb leads (aVf, aVL, and aVr), and
the precordial, or chest, leads (V1 through V6).

Purpose of Electrocardiography (ECG)

 To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac

hypertrophy, pericarditis, electrolyte imbalances, myocardial ischemia, and the
site and extent of myocardial infarction.
 To monitor recovery from an MI.
 To evaluate the effectiveness of cardiac medication.
 To assess pacemaker performance
 To determine effectiveness of thrombolytic therapy and the resolution of ST-
segment depression or elevation and T-wave changes

 ANATOMY AND PHYSIOLOGY

The heart’s job is to pump blood around the body. The heart is located in
between two lungs. It lies left of the middle of the chest.
The main function of the cardiovascular system is therefore to maintain blood
flow to all parts of the body, to allow it to survive. Veins deliver used from the
back to the heart. Blood in the veins is low in oxygen ( as it has been taken out
by the body) and high in carbon dioxide (as the body has unloaded it back into
the blood).
All the veins drain into the superior and inferior vena cava which then drain into
the right atrium. The right atrium pumps blood into the right ventricle. Then the
right ventricle pumps blood to the pulmonary trunk, through the pulmonary
arteries and into the lungs. In the lungs the blood picks up oxygen that we breath
in and gets rid of carbon dioxide, which we breath out.
The blood is becomes rich in oxygen which the body can use. From the lungs,
blood drains into the left atrium and is then pumped into the left ventricle. The left
ventricle then pumps this oxygen-rich blood out into the aorta which then
distributes it to the rest of the body through other arteries.