The given study talks about Mr. Patrick, a 78-year-old male having a deterioration of his left-sided heart failure and COPD. He presents with symptoms including dypsnea and regular cough along with swelling of his legs below the knee. He is walking slowly and is very tired. On assessment, his blood pressure was 135/85 mm Hg (towards normal), heart rate was 155 bpm(towards the higher side), weight is 95 kgs, and waist circumference is 104 cm. He has a history of a Myocardial infarction due to an occlusion in a branch of his left carotid artery at age 68 and a history of smoking from age 20 till 60 years of age. He quit smoking in his 60s. This case study will discuss the pathophysiology of his respiratory symptoms along with the relationship between his left-sided heart failure and COPD.
His respiratory symptoms include regular coughing and dyspnea and difficulty in breathing. His condition of COPD is characterized by a poorly reversible obstruction to airflow associated with an increasing and abnormal inflammatory response in the lungs. The inflammatory response is the adaptive, innate immunological response of the body to a long term exposure to cigarette smoke, as in the case of Patrick. This abnormal response leads to hypersecretion of mucus, emphysema (tissue destruction) and bronchiolitis (inflammation of the small airway and its fibrosis). These changes occurring pathologically cause increase in the airflow resistance in the small airways, air trapping, increased lung compliance and progressing obstruction to airflow. This hypersecretion causes productive coughing in the patients as observed in Patrick’s case. Air trapping in expiration causes hyperinflation at rest which in turn reduces the inspiratory capacity and hence, the FRC during exercise (Anzueto, 2017). These features cause breathlessness and shortness of breath as seen in Patrick’s case. The left side of the heart gets oxygenated blood from lungs via the pulmonary veins which are pumped in the body by the left ventricle. When the left heart fails, the heart is not able to pump the oxygenated blood to the rest of the body. It causes an increase in the backpressure at the level of lungs, causing pulmonary hypertension which leads to exudation of fluid in the alveoli and pulmonary edema as well. This leads to patient feeling breathless or dyspneic as well (Brake & Jones, 2017). It causes hyperventilation at the level of the lungs and the rate of breathing increases and feels “dyspneic” as observed in Patrick’s case.
Left side heart failure is a progressive condition where the left ventricle is unable to pump blood around the body. This causes blood to build up and collect in the pulmonary veins (the blood vessels responsible for carrying blood away from the lungs). This build-up of fluid in the lungs leads to shortness of breath, difficulty breathing or coughing as well- especially during stressful conditions like doing physical activity. As observed in Patrick’s case, he has symptoms of dyspnea and coughing as well. More common causes of this inability of the left ventricle to pump adequate blood to the body are coronary artery disease, or a previous heart attack (Brake& Jones, 2017). Patrick has a history of both- occlusion of left coronary artery and myocardial infarction as well. His high lipid profile suggests he still has high cholesterol, which might still be aggravating the occlusion and thus, strain on his left ventricle and heart failure as well.
There exists no direct relation between COPD and left-sided heart failure. However, they can exist together and cause exacerbation of each other. COPD causes decreased levels of oxygen in the blood, which places extra stress on the heart and exacerbates the left-sided heat failure. The left-sided heart failure contributes to buildup of fluid in the lungs, which worsens and aggravates the COPD symptoms (Güder& Stork, 2019).
Anzueto, A., &Miravitlles, M. (2017).Pathophysiology of dyspnea in COPD. Postgraduate Medicine, 129(3), 366-374.
Brake, R., & Jones, I. D. (2017). Chronic heart failure part 1: Pathophysiology, signs and symptoms. Nursing Standard, 31(19), 54.
Güder, G., &Störk, S. (2019). COPD and heart failure: Differential diagnosis and comorbidity. Herz, 44(6), 502-508.
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