St.

Michael’s College of Laguna

School of Nursing and Midwifery

A Partial Fulfillment in Related Learning Experience III

A Case Study of
Hypertensive
Cardiovascular Disease
(HCVD)

Submitted by:

Angelique A. Malabo

Airish Nyn Manzo

BSN3B

Group8

Submitted to:

Sir Lloyd Lopez

29November2008
 St. Michael’s College of Laguna
School of Nursing and Midwifery

INTRODUCTION

Cardiovascular disease or cardiovascular diseases refers to the

class of diseases that involve the heart or blood vessels (arteries and
veins). [1] 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 have similar causes,
mechanisms, and treatments. In practice, cardiovascular disease is
treated by cardiologists, thoracic surgeons, vascular surgeons,
neurologists, and interventional radiologists, depending on the organ
system that is being treated. There is considerable overlap in the
specialties, and it is common for certain procedures to be performed
by different types of specialists in the same hospital.

Most countries face high and increasing rates of cardiovascular

disease. Each year, heart disease kills more Americans than cancer.

It is the number one cause of death and disability in the United States
and most European countries (data available through 2005). 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.

Hypertensive cardiovascular disease also known as hypertensive heart

disease occurs due to the complication of hypertension or high blood
pressure. In this condition the workload of the heart is increased
manifold and with time this causes the heart muscles to thicken. The
heart continues pumping blood against this increased pressure and
over a period of time the left ventricle of the heart enlarges and this in
turn causes the blood pumped by heart to reduce. If proper treatment
is not taken at this stage then symptoms of congestive heart failure
may be observed.

High blood pressure or hypertension is among the top most factors

associated with cardiovascular diseases. This can result in ischemic
heart disease. High blood pressure is also a contributing factor to the
eventual thickening of walls of blood vessels. This increases the
possibility of heart attacks and strokes. Hypertensive cardiovascular
disease is among the leading killers in present times. Around 7 people
out of every 1000 suffer from this disease. Heredity is an important
factor so far as people suffering from hypertension are concerned.
Other factors include excessive consumption of salt and excessive
stress.
 St. Michael’s College of Laguna
School of Nursing and Midwifery
Symptoms

It usually takes some time for the problem of high blood pressure to
eventually lead to hypertensive cardiovascular disease and therefore
high blood pressure is often called the silent killer. Eventually
hypertensive heart disease can also lead to congestive heart failure.
Some symptoms of hypertension and the eventual congestive heart
failure include arrhythmias, shortness of breath, weakness and fatigue,
swelling in lower extremities and greater frequency of urination during
the night. Hypertensive cardiovascular disease may also result in
ischemic heart condition and in this case there might be chest pain,
sweating and dizziness, nausea and shortness of breath. Hypertrophic
cardiomyopathy could also be a result of hypertensive heart disease.

Tests

Usually the first signal is elevated blood pressure together with a

possibility of enlargement of the heart. Fluid within the lungs may also
be found in preliminary examination by using the stethoscope and
some abnormal heart sounds may also be detected. ECG is ordinarily
done and this may show abnormal results in those who have possible
hypertensive cardiovascular disease. Evidence of ischemia which is the
lack of oxygen in the heart muscle may also be detected. Some other
tests ordinarily conducted may include a chest X ray, a CT scan of the
chest, echocardiogram and coronary angiogram.

Treatment

The primary aim of any treatment in hypertensive cardiovascular

disease is reduction of blood pressure and then eventual control of the
heart disease. The line of treatment will ordinarily depend on the
condition such as whether there is angina or acute myocardial
infarction. The line of treatment may include beta blockers, angiotensin
converting enzyme inhibitors (ACE), calcium channel blockers, diuretics
etc depending upon particulars of each individual case. The blood
pressure is consistently required to be checked and kept under control
in this condition.

Likewise people experiencing hypertensive cardiovascular disease

have to make certain changes in their lifestyle and diet patters. These
would ordinarily include weight loss where obesity is identified,
moderate exercise as per directions of the medical professional and
adjustments in the diet. These adjustments would include intake of
healthy food including vegetables, fresh fruits and low fat dairy items.
Smoking is also a contributing factor to hypertension and therefore
these lifestyle changes would have to include the patient quitting
smoking. Consumption of fish, whole grains are also recommended. In
the long run the outcome largely depends on the possibility and extent
of complications. In hypertensive cardiovascular disease the treatment
will depend largely on the degree of enlargement of the left ventricle.
However some medicines such as

PATIENT’S PROFILE
 St. Michael’s College of Laguna
School of Nursing and Midwifery

Name: Anicia N. Dilag

Age: 55
Sex: female
Civil status: Widow
Nationality: Filipino
Address: 205 Nielo St. Platero, Biñan, Laguna
Religion: Roman Catholic
Birthday: December 30. 1953
Attending Physician: Dr. Mina
Admitting Physician: Dr. Leslie Bumarlong
Date of admission:
Time of Admission: 11:10 pm
Admission Diagnosis: HCVD; AMI
Final Diagnosis: HCVD; CAP
Chief Complain: DOB
Past Medication History:
• Hypertension
• Hypercholesterolemia
Past Hospitalization:
• 1997, exlap, ovarian cyst
Family History:
• Hypertension

History of Illness:

Few hours PTC patient had an argument with her brother and
then had DOB associated with chest pain prompting consult at ER and
was admitted. After the assessment and series of examinations, the
patient was diagnosed of having Hypertensive Cardiovascular Disease
(HCVD).

ANATOMY AND PHYSIOLOGY

 St. Michael’s College of Laguna
School of Nursing and Midwifery

An Introduction to the Cardiovascular System

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

 St. Michael’s College of Laguna
School of Nursing and Midwifery
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 allow them to perform more work by pumping out blood to
the whole body.

Blood Vessels
 St. Michael’s College of Laguna
School of Nursing and Midwifery
Blood Vessels 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
the superior 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. The aortic 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.

Components of Blood

Health conscious individuals should be especially concerned with

maintaining a healthy cardiovascular system. While the heart, which is
a powerful automatic pump, is the cardiovascular component we think
of most often, the blood and the blood vessels are also vital to
maintaining good health.

The average adult has between 5 to 6 liters of blood or blood volume.

The blood carries oxygen and essential nutrients to all of the living
cells in the body, and also carries waste products to systems that
 St. Michael’s College of Laguna
School of Nursing and Midwifery
eliminate them. Most of the blood is made up of watery,
protein-laden fluid called plasma. A little less than half of this blood
volume is composed of red and white blood cells, and other solid
elements called platelets.

Platelets are responsible for coagulation of blood at the point of an

injury to a blood vessel.

Without platelets, our blood would not be able to clot and

hemorrhaging or uncontrolled bleeding would result. Hemophilia is a
genetic condition, which results in individuals with no ability to clot.
Also called bleeders, these individuals must periodically administer a
clotting factor to their blood to prevent the constant bleeding, which
occurs.

How Blood Clots

Let’s examine how platelets work to form clots. Here's a cut section of
a small artery. The traffic going by includes red blood cells carrying
oxygen; platelets, which come from white blood cell fragments; and
clotting factors, which help the blood to clot. When a blood vessel
becomes damaged, as shown here, the blood cells and plasma begin
oozing out into the surrounding tissue. This begins the clotting process.
Platelets immediately begin to adhere to the cut edges of the artery;
they release chemicals to attract even more platelets. Eventually a
platelet plug is formed, and the external bleeding stops.

Inside, the clotting factors take a much more active role by creating a
cascade of clotting activity. The clotting factors cause strands of blood-
borne material, called fibrin, to stick together and seal the inside of the
wound. Eventually, the cut blood vessel heals, and the blood clot
dissolves after several days.

While platelets play an important role in clotting, red blood cells carry
on the important job of carrying oxygen and other nutrients to all the
tissues of the body and carrying waste products to the organs, which
remove them from the body.

How Red Blood Cells Carry Oxygen

 St. Michael’s College of Laguna
School of Nursing and Midwifery
Red blood cells are the oxygen carriers. As they travel
away from the heart, they traverse smaller and smaller arteries, finally
arriving at the collections of microscopic blood vessels known as
capillaries. Here, they exchange nutrients and oxygen for cellular
waste products. The waste products are eventually eliminated from the
blood stream through the urinary and respiratory systems.

The exchange of oxygen and nutrients between the red blood cells and
the surrounding tissues occurs through a process called diffusion. In
diffusion, when capillaries contain a high concentration of oxygen and
nutrients, while the surrounding tissues contain a lower concentration,
Oxygen and nutrients leave the capillaries and enter the tissues.

Conversely, when body tissues contain high concentrations of carbon

dioxide and metabolic waste, while the capillaries contain a lower
concentration, the waste products diffuse from the tissues into the
capillaries and from there are carried by the venous system back
toward the heart.

Blood Pressure

The red blood cells transport oxygen and waste products by flowing
through the blood vessels. What causes blood to flow through the
vessels is blood pressure. Just as water flows through pipes from areas
of greater pressure to lesser, so too the blood flows through the body
from areas of higher pressure to areas of lower pressure. Blood
pressure is measured both as the heart contracts, which is called
systole, and as it relaxes, which is called diastole. A systolic blood
pressure of 120 millimeters of mercury is considered right in the
middle of the range of normal blood pressures, as is a diastolic
pressure of eighty. In common terms, this normal measurement would
be stated as "120 over 80".
 St. Michael’s College of Laguna
School of Nursing and Midwifery
Normal blood pressure is important for proper blood flow to
the body's organs and tissues. Each heartbeat forces blood to the rest
of the body. The force of the blood on the walls of the arteries is called
blood pressure. Blood pressure moves from high pressure near the
heart to low pressure away from the heart. Blood pressure depends on
many factors, including the amount of blood pumped by the heart. The
diameter of the arteries through which blood is pumped is also an
important factor. Generally, blood pressure is higher when more blood
is pumped by the heart, and the diameter of an artery is narrow.

Systolic pressure is measured when the heart ventricles contract.

Diastolic pressure is measured when the heart ventricles relax.
Stressful situations can result in a temporary increase in blood
pressure. If an individual were to have a consistent blood pressure
reading of 140 over 90, he would be evaluated for having high blood
pressure. If left untreated, high blood pressure can damage important
organs, such as the brain and kidneys as well as lead to a stroke.

PATHOPHYSIOLOGY
 St. Michael’s College of Laguna
School of Nursing and Midwifery

LABORATORY AND DIAGNOSTIC EXAMS

Date:
11/20/2008
 St. Michael’s College of Laguna
School of Nursing and Midwifery
Result Normal Values
Examination
HGT 5pm 145 71-111mg/L
MHgb AIC 5.9% 4.6-6.6

X-RAY DEPARTMENT

Name: Anicia Dilag Date: 11/16/2008 Age:

55
Address: Platero Biñan, Laguna Sex: F CS:
Exam: CHEST AP

The lung fields are clear. The heart is transversely oriented and
appears markedly enlarged, partly due to magnification being in the
supine, AP projection. The aorta is tortuous and faintly calcified. The
hemi diaphragms are elevated.

Conclusion:
Poor inspiratory effort, consider cardiomegaly (Left ventricle
preponderance) atheromatous aorta.

MAGIC EIGHT
Nov. 17, 2008

Examination Result Normal Values

B Glucose 8.0 mmo/L 3.9 to 5.8
B BUN 2.6 2.5 to 6.5
B Creatinine 66.5 vmo/L 35.0 to 150.0
B Uric Acid 318.9 vmo/L 150 to 420
B Cholesterol 2.8 mmo/L 0.0 to 5.2
B Triglyceride 1.2 0.7 to 1.7
B HDL Direct 0.8 0.0 to 1.6
LDL 1.8 0.0 to 3.34
 St. Michael’s College of Laguna
School of Nursing and Midwifery