Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation
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Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation
Deborah is 56 years old, smokes a half a pack of cigarettes a day, and is overweight. Her friend wants her to come to a local women’s fitness class she attends once a week. She knows Deborah’s dad had died of an acute myocardial infarction when he was 56, and she fears, seeing Deborah’s lifestyle, the same fate awaits her friend. What she did not know was that Deborah had also been to her doctor for her annual physical where she was told her LDLs were 180 mg/dL, HDLs were 36 mg/dL, and cholesterol was 239 mg/dL.
What are Deborah’s known risk factors for coronary heart disease?
Deborah’s doctor referred her to a dietician for strict dietary therapy, hoping the intervention would raise her HDL and lower her LDL and cholesterol levels. Why is diet modification necessary to control and moderate the lipids indicated?
Deborah’s doctor also gave her pamphlets describing strategies to stop smoking and a list of exercise ideas she might want to try. How is smoking thought to contribute to atherosclerotic plaque formation? Why would exercise have a positive effect on Deborah’s lipid profile?
Atherosclerosis is thought to be an inflammatory disorder. What is the role of macrophages in the formation of atherosclerotic plaques? What is the significance of elevated serum hs-CRP levels in at-risk individuals?
Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation
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Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation
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Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation
Introduction
The high incidences of chronic and non-communicable conditions result from multiple factors. One of the major factors playing a critical role in developing these chronic conditions is certain lifestyle behaviors, which puts an individual at an increased risk of developing some of these conditions. Affected individuals have a low quality of life, increased incidences of hospital admissions, and even death. Early identification of the risk factors and health promotion through health education on behavior modifications are crucial in preventing the development of these conditions and preventing their progression, resulting in life-threatening complications (Helgeson & Zajdel, 2017). This paper examines and discusses a related case study and how certain factors increase Deborah’s risk of developing life-threatening complications.
Deborah has known risk factors for coronary heart disease.
Coronary heart diseases are among the leading causes of cardiovascular-related deaths globally. Various factors have been implicated in its etiology, which can be either modifiable or non-modifiable. In Deborah’s case scenario, both modifiable and non-modifiable factors could increase her risk of developing coronary heart disease and associated complications (Hajar, 2017). The significant non-modifiable risk factor is the family history of heart disease since her dad died of acute myocardial infarction. The modifiable risk factors which she can work on to lower her risks include; smoking half a pack of cigarettes a day, lack of physical activity, and high cholesterol and LDL levels, which could be due to an unhealthy diet (Pencina et al., 2019). These are known factors of cardiovascular diseases, including coronary heart diseases. However, the latter is modifiable; therefore, Deborah can work on them through the help of a caregiver to lower her risk of developing coronary heart disease.
Why diet modification is necessary to control and moderate the lipids indicated
High lipids, especially LDLs and cholesterol, are unhealthy and increase the risk of developing various cardiovascular conditions, including coronary heart diseases and associated complications such as heart attack and even death. The major contributor to high lipid levels in the blood is a fatty and unhealthy diet. HDL is regarded as good cholesterol and therefore is a predictor of protection against the effects of LDL and cholesterol. Consuming a high-fat diet, especially unsaturated fat, increases the levels of LDL and cholesterol, which are bad cholesterols and predisposes one to a high likelihood of developing related heart conditions (Blesso & Fernandez, 2018). Therefore, recommending a dietician’s intervention would help regulate the intake and help Deborah adopt a healthy diet with a well-controlled fat intake.
Controlling the intake of fats helps regulate the levels of cholesterol and other lipids in the body to healthy levels, with associated less risk of developing various cardiovascular conditions. One of the effective interventions in lowering the LDL and cholesterol levels and increasing HDL levels, which are regarded as good cholesterol, is ensuring a low carbohydrate diet (Blesso & Fernandez, 2018). This will be useful in lowering the risk associated with high LDL and cholesterol levels in the body.
How is smoking thought to contribute to atherosclerotic plaque formation? Why would exercise have a positive effect on Deborah’s lipid profile?
Smoking is one of the behavioral risk factors associated with multiple health conditions, for instance, cancers and cardiovascular diseases. The cigarette has thousands of chemicals that have been identified to be associated with various health conditions (Wang et al., 2017). The correlation between smoking and atherosclerosis has been shown in different ways. The toxins present in the smoke have been shown to increase the LDL levels while at the same time reducing the HDL levels, which are regarded as good cholesterol. Other constituents of tobacco smoke, including carbon monoxide and nicotine, are known causes of endothelial injury. In response to the injury caused to ensure repair, a favorable environment enhances plaque build-up (Wang et al., 2017). Plaque formation and build-up, erosion due to blood flow, and further build-up cause more and more injuries, contributing to atherosclerosis’s advancement. Smoking in individuals with hypertension also increases the risk of malignant hypertension, which can also cause endothelial injury and subsequent plaque formation and build-up (Wang et al., 2017).
Deborah’s lipid profile results show high levels and could significantly predispose her to higher risks of developing coronary heart disease. This could be adjusted in various ways, including regulating dietary fat intake to minimize the levels. Given that she is overweight, dietary intake alone would not be effective in lowering the lipid levels. It is also challenging to ensure strict adherence to a safe and healthy diet (Helgeson & Zajdel, 2017). Therefore, physical activity and exercise play a critical role in lowering the high lipid levels and reducing the risk associated with such high cholesterol levels in the blood. Besides, exercise increases HDL levels, considered good cholesterol due to its role in clearing cholesterol from plaques. They, therefore, reduce the risk of coronary artery diseases and other cardiovascular diseases (Helgeson & Zajdel, 2017). The more intense and prolonged the exercise is, the more effective it will be in clearing off cholesterol, LDLs, and triglycerides and reducing Deborah’s weight to healthy levels.
What is the role of macrophages in the formation of atherosclerotic plaques?
The formation of atherosclerotic plaques is considered a chronic inflammatory process in which macrophages play a significant role. After developing an atherosclerotic lesion, macrophages maintain a pro-inflammatory environment, thereby enhancing the formation of unstable and complicated plaques (Wang et al., 2017). In the atherosclerotic lesion, macrophages also increase in number, increasing the accumulation of cholesterol. On the other hand, the anti-inflammatory macrophages enhance tissue repair and remodeling and subsequent plaque stabilization (Wang et al., 2017).
What is the significance of elevated serum hs-CRP levels in at-risk individuals?
High-risk patients require regular monitoring and evaluations to identify any life-threatening trend which may cause death if not effectively addressed. One of the most useful monitoring parameters is the levels of hs-CRP. This is an inflammatory marker that can predict the seriousness of inflammation within the body and a possible predictor of mortality in patients with certain conditions such as coronary artery disease (Swastini et al., 2019). Healthcare professionals use hs-CRP levels to predict the progress and mortality in patients at risk of developing coronary artery diseases, such as the obese and those with high cholesterol levels. High levels may also indicate a response to an acute infection, possible trauma, or other inflammatory conditions. It is also used in monitoring the effectiveness of interventions developed to prevent the development of coronary artery diseases in high-risk patients. It can also be used to monitor therapy, for instance, the effectiveness of exercise and diet modifications in high-risk patients (Swastini et al., 2019).
Given the various factors that increase Deborah’s risks of developing coronary heart disease, interventions should enhance health promotion through health education and encouraging behavior modification to reduce the associated risks.
References
Blesso, C. N., & Fernandez, M. L. (2018). Dietary cholesterol, serum lipids, and heart disease: are eggs working for or against you?. Nutrients, 10(4), 426. https://www.mdpi.com/277206
Hajar, R. (2017). Risk factors for coronary artery disease: historical perspectives. Heart views: the official journal of the Gulf Heart Association, 18(3), 109. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5686931/
Helgeson, V. S., & Zajdel, M. (2017). Adjusting to chronic health conditions. Annu Rev Psychol, 68(1), 545-571. https://smartlib.umri.ac.id/assets/uploads/files/812b2-annurev-psych-010416-044014.pdf
Pencina, M. J., Navar, A. M., Wojdyla, D., Sanchez, R. J., Khan, I., Elassal, J., … & Sniderman, A. D. (2019). Quantifying the importance of major risk factors for coronary heart disease. Circulation, 139(13), 1603-1611. https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.117.031855
Swastini, D. A., Wiryanthini, I. A. D., Ariastuti, N. L. P., & Muliantara, A. (2019). Atherosclerosis prediction with high sensitivity C-reactive protein (hs-CRP) and related risk factor in patient with dyslipidemia. Open access Macedonian journal of medical sciences, 7(22), 3887. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7048367/
Wang, Z., Wang, D., & Wang, Y. (2017). Cigarette smoking and adipose tissue: the emerging role in progression of atherosclerosis. Mediators of inflammation, 2017. https://www.hindawi.com/journals/mi/2017/3102737/
Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation