Pulmonary Embolism (PE) is one of the deadly chronic infections and is common among the aging population. The condition is not selective and disproportionally Affects nations with poor and moderate incomes. PE is a sudden blockage in a major artery in the lung. Sometimes Blood clots that develop in another part of the body (plaque) may break off and travel within the bloodstream into the lungs, causing a blockage in the heart and preventing it from receiving oxygenated blood. PE is the 3rd most deadly cardiovascular disease after a heart attack and stroke (Noubiap et al., 2019). Dyslipidemia is an important modifiable risk factor for pulmonary Embolism. It occurs when the blood has too many fatty acids/lipids. A person with these conditions will likely experience the formation of plagues or clots within their vessels/arteries. Research has already proven that blood with high fat (cholesterol) proportions is more likely to form clots (CleverlandClinic, 2022). These clots may form directly (around the lungs or heart) or form in other body regions but break off after some time to cause a blockage within the heart regions. This prevents the heart from receiving oxygenated blood from the lungs and hence may experience a cardiac attack due to strenuous performance and low oxygen supply. Hyperlipidemia is exacerbated by drug effects (taking drugs for other long-term conditions) and chronic alcoholism (Cho et al., 2018). This paper will address the pathophysiology of the patient’s current condition and how it connects to her history of hyperlipidemia.
Patient History and pathophysiology
Medically, hyperlipidemia refers to a condition in which the blood contains unusually high quantities of fats and lipids. The condition occurs due to high cholesterol in the blood and is second after hypercholesterolemia, even though the two terms can be used interchangeably. Cholesterol is healthy for the body; it’s not harmful in the right proportions. Cholesterol is a vital component of the heart that prevents shock waves and is also an important factor in the digestion of foods. Hyperlipidemia condition implies that the blood has excess lipids (fats). The danger with too many fats in the body is that they easily form plagues within the arteria or venal walls, which may lead to a blockage of main blood pathways. Other names for the condition include dyslipidemia or lipid imbalance of high cholesterol. The condition is caused by the extra cholesterol which comes from the food we take. The liver’s bile contains sufficient cholesterol to aid digestion and the production of hormones.
Cholesterols may also be present in the meat and dairy shops. Therefore since the liver has already made sufficient cholesterol for body usage, cholesterol in foods becomes extra. High cholesterol levels (240 mg/dl or more) may induce blockages in the arterials that connect to vital body organs and lead to heart disease and stroke (Kubala, 2022). This may cause organ damage due to an insufficient supply of resources (blood, air, and nutrients). Drinking alcohol also increases cholesterol levels in the body.
According to the case study, the patient’s pathophysiology of hyperlipidemia is induced by chronic ethanol intake. Alcohol intake affects cholesterol levels, depending on the level and frequency of intake. The patient has been a chronic alcoholic, and hence blood circulation within her body had a lot of cholesterol. Over time, the accumulation of excess fats in the artery walls results in the formation of plaques. Heavy buildup of plaques causes narrowing of blood vessels, a process called atherosclerosis.
In most cases, people do not experience symptoms of hyperlipidemia. However, the condition may increase the risk of developing heart disease and increase the likelihood of having a major stroke and or hence death. Hardened plaque (cholesterol deposits) may build up in blood arteries caused by low-density lipoprotein (LDL) cholesterol. This may make it difficult for blood to flow, increasing the risk of heart disease. Risk factors of hyperlipidemia include a family history of high cholesterol, obesity, hypothyroidism, poor nutrition, alcohol (chronic ethanol intake), diabetes, and smoking. Hyperlipidemia can be very serious if left untreated (Kubala, 2022). Most patients with these conditions also suffer from cardiovascular disease. This is the most common terminal infection of hyperlipidemia in America, followed by cerebrovascular accidents (ischemic stroke), and lastly, pulmonary Embolism.
Current status and suspected pathology/physiology
Most individuals above 50 years are at a high risk of developing chronic problems due to aging. The most common condition affecting aging people includes obesity, diabetes, heart disorders, arthritis, and brain disorders. These conditions could be primary infections, coming from our lifestyles or foods we take, or secondary infections, infections that develop as a result of comorbid conditions (other underlying infections).
The patient, in this case, has been quite unlucky. She has survived hyperlipidemia and arthritis (Hip), and she is gradually developing other infections as has been witnessed by symptoms and complaints of chest pains, shortness of breath (dyspnea), and tachycardia as observed by fast heartbeats (arrhythmias). Prior to the current health symptoms, the patient underwent a major surgery operation. Arthritis is a common disorder caused by the wear and tear. In most cases, arthritis is caused by joint overuse and is most common in patients above 50years.
Osteoarthritis occurs due to wear and tear of the joint cartilage, and this causes pain a restricted movement. One common type of arthritis is osteonecrosis of the hip region. Osteonecrosis refers to bone death due to insufficient blood flow and frequently occurs in the hip and shoulder regions and may sometimes affect other large joints like the ankle, wrist, knee, and elbow. (MayoClinic, 2022). The etiology for this osteonecrosis is suspected of emanating from hyperlipidemia and its drug treatment effects, causing heavy plaque accumulation in blood vessels. There was a great chance that the patient had experienced a blockage or narrowing of major blood vessels supplying the hip bone regions and hence death of the hip bones (osteonecrosis). Drugs used to suppress hyperlipidemia, such as statins, have high uric acid levels; and may cause joint cartilage to stiffen and the lubricants to dry, increasing frictions, wear, and tear. With other risk factors such as obesity, previous injury, age, and sex, people taking drugs for other underlying conditions may eventually develop arthritis.
The patient underwent a total/bilateral hip replacement due to osteonecrosis of the hip. Such major surgical operations usually leave a patient immobile before a period of full recovery. While taking additional drugs for both the surgical operation and the ones for managing cholesterol, the patient was at a very high right of developing blood clots. Additionally, she could not exercise or conduct required physical exercises as needed for patients with such a condition. I believe that the drug effects may have exacerbated fat/plague deposits in her major arteries.
Over time, blood clots formed in other regions of the body, such as the legs, may “break off” and travel through blood circulation into the major organs such as the lungs and the heart, where they cause a blockage (Deep Vein thrombosis). Pre-existing clots, in this case, are suspected of having entered the bloodstream to cause a blockage of major arteries within the lungs, a condition called Pulmonary Embolism (PE). The patient’s confirmatory symptoms that she could be experiencing a PE and or hypertension with lifelong implications such as shortness of breath (dyspnea) and strenuous heart performance (tachycardia) characterized by faster heartbeats to keep ups with oxygen demand and other resources.
Currently, there is no established system for classifying PE. The significance of PE is that it may result in a shortage of blood flow, which can destroy lung tissue. It may also produce low oxygen saturation, harming other organs and systems. A large PE or a high concentration of clits in the blood may result in a sudden and significant life-threatening disease and even death. Patients suffering from a PE, for example, are at significant risk of developing severe heart failure and other cardiac illnesses owing to a lack of oxygen.
However, diagnosis and strict adherence to a doctor’s prescription may significantly protect against PE and cause clots to disappear eventually. People living with PE are encouraged to exercise regularly to burn fats and normalize diets with low-fat content. They may also meditate with drugs meant to suppress cholesterol levels. Symptoms of PE begin and may include sudden shortness of breath, pain in the back, sharp chest pains aggravated by coughing or movement, rapid pulse rates, breathlessness and shortness of breath, light-headedness, and feelings of passing out.
Diagnosis and role of imaging
The term “patient pathway” refers to all of the phases that a patient goes through in the care and management of his or her condition, starting with pre-diagnosis and continuing through palliative care and beyond. It is difficult to identify Pulmonary Embolism (PE) since the indicators of PE are similar to those of many other ailments and diseases. In addition to a thorough clinical examination, their test is utilized to determine whether or not there is PE.
One of the easiest, quickest, and cheapest techniques to examine the lungs and the heart is the Electrocardiogram (EKG). It used electrodes placed on the chest, legs, and arms, which generate a printed report when connected to the EKG machine. An evaluation of blood clot risk is done by measuring the heart and interpreting the results. Chest X-ray imaging is used to assess the lings and their heart. It reveals information about the size, shape, and contour of the heart, lungs, and other arteries. This helps to identify the location of the Deep vein thrombosis (DVT) and establish the treatment options. Ventilation-perfusion (V/Q) scan is also used in combination with an X-ray. A ventilation scan is used to examine and evaluate blood flow within the lungs or airways within the lungs (bronchi and bronchioles). These diagnostic can be performed once in medical check-ups to monitor the disease’s progress and how the current medical interventions are suppressing it.
Other tests, such as pulmonary angiogram, which evaluates bulging arteries (aneurysm) and other issues narrowing (stenosis), or other minor blockages. Injecting the dye causes veins to appear on X-yay hence makes it easy to identify areas of weakness. On the other hand, Dupe ultrasound can be used to assess blood circulation and the morphology of the leg’s blood arteries. This is important because most blood clots in the legs often dislodge and travel into the lungs. Lastly, lab tests are also relevant in the management and diagnosis of PE. Serum tests are used to determine blood’s ability to clot and frequently use a test called the D-diet test. It detests certain elements in the blood, which increase the risk of blood clotting.
Anticoagulants are the main drug treatment prescribed for PE patients. Anticoagulants such as warfarin and heparin help to decrease the blood clotting ability. Preventing an existing clot from growing or creating additional clots is the goal. IV injection of fibrinolytic or “clot busters” can be administered to patients to break down the clot. These medicines are, however, sued in life-threatening conditions. Another effective therapy involves the placement of a metallic device on the main vein. Vena cava filtering helps keep blood clots from entering the lungs and the heart. When a patient is not responding to anticoagulation medication or has bleeding while taking anticoagulants, this intervention may be utilized as an alternative.
Pulmonary Embolism occurs as the formation of a blood clot on the major veins surrounding the lungs. The etiology of this disorder is believed to have emanated from a history of hyperlipidemia and excessive alcohol intake, which altogether increase the rate of blood clotting and plaque accumulation. Hyperlipidemia causes a narrowing of blood and a decrease in the supply of nutrients in the body organs. The patients must have experienced an insufficient supply of blood in the hip region which caused the death of the hip bones (osteonecrosis). Pathophysiological processes eventually accumulate blood clots in these regions, and with time, dislodging may occur. Dislodged blockages from the legs and other regions of the body travel towards the heart and the lungs causing a blockage and hence a serious health issue like the one of PE the patient is experiencing. It is necessary to observe medications such as anticoagulants and perform regular physical exercise. This can help minimize the possibility of clot formation in the blood and eliminate the existing ones.
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Cleveland Clinic. (2022). Hyperlipidemia: What Is It, Causes, Symptoms, Diagnosis & Treatment. https://my.clevelandclinic.org/health/diseases/21656-hyperlipidemia.
Kubala, M. J. S. (2022, March 8). Can Drinking Alcohol Affect Your Cholesterol Levels? Healthline. https://www.healthline.com/health/high-cholesterol/effects-of-alcohol.
Mayo Clinic. (2021, September 15). Arthritis – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772
Noubiap, J. J. N., Nansseu, J. R. N., Bigna, J. J. R., Jingi, A. M., & Kengne, A. P. (2019). Prevalence and incidence of dyslipidemia among adults in Africa: a systematic review and meta-analysis protocol. BMJ Open, 5(3), e007404.