Cardiovascular Accident Case Study
Case: Mr. Quinn, age 64 years, developed a severe headache several hours ago that has not responded to acetaminophen. Now his speech is slurred, and his right arm and the right side of his face feel numb. He is very anxious and is transported to the hospital. Mr. Quinn has a history of smoking and arteriosclerosis, and there is family history of CVA and diabetes. Assessment at the hospital indicated weakness on the right side, including facial asymmetry and a blood pressure of 220/110 Hg mm. A CT scan showed damaged tissue on the left side of the brain, and an angiogram indicated narrowing of the carotid arteries and middle cerebral arteries, with occlusion of the left middle cerebral artery.
Question 1
Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma.
Thrombus occurs when there is a blood clot that forms in the arteries of the brain, while an embolic stroke occurs when there is a blood in another part of the body like the heart that dislodges and flows up to the smaller arteries of the brain where it gets stuck. Atheroma is the gradual narrowing of the artery. This is due to plaque and thrombus. Usually, it occurs over a period of time.
Related study material: NRSG 408 MI Clinical Case Study Solutions
Question 2
Explain the predisposing factors in this case, and relate Mr. Quinn’s initial signs to the pathological changes.
Predisposing factors in Mr. Quinn’s case would be the narrowing of the carotid and middle cerebral arteries, also occlusion of the left middle cerebral artery. Initial signs would be headache, anxiousness, numbness and loss of speech.
Question 3
Discuss the treatments available after first aid for stroke patients and the patient’s prognosis.
Treatments available are; tissue plasminogen activator (TAP) to reduce effects of CVA, glucocorticoids to reduce edema, assisting to maintain muscle tone, therapists, speech therapy, treating underlying problem.
Case Study: Cardiovascular System – Atherosclerosis
Case: Mr. Kelly is a 57-year-old man who consulted his physician after noticing marked leg pains while playing golf. He had previously noticed increasing fatigue and discomfort in his legs associated with moderate exercise. When sitting for extended periods with legs dangling, his legs became red, and sometimes his feet felt numb. His history indicates he smokes cigarettes and is chronically overweight. His blood cholesterol and other lipid levels are abnormal, and his physician suspects’ peripheral atherosclerosis as the cause of his discomfort.
Question 1
Discuss the development of atherosclerosis, including the predisposing factors in this case and the pathophysiological changes.
Atherosclerosis is a slow and progressive disease. Individuals who smoke, have high blood pressure and consume too much cholesterol are at risk. Atherosclerosis is when fatty deposits clog up the arteries. These deposits are called plague and there are made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin. As the plaque builds up the artery wall gets thicker, this narrows the opening and decreases blood flow and decreases the supply of oxygen to the cells.
The case shows that Mr. Kelly is chronically overweight and smokes cigarette. Also his lab values for cholesterol and lipid levels were abnormal, this indicates the reason for the physician suspecting atherosclerosis.
Question 2
Discuss the complications that might develop in this patient.
The patient has many symptoms. However, the types of signs will determine whether there will be a buildup of plaque in the carotid arteries or coronary arteries. The fact that Mr. Kelly has peripheral atherosclerosis, it puts him at a higher risk for coronary artery disease, heart attack or stroke. If left untreated it can also lead to gangrene or amputation of limbs. Carotid arteries provide blood to the brain, the patient will experience weakness, difficulty breathing, headache, facial numbness and paralysis. In Coronary arteries, which provide blood to the heart, the patient will present with chest pain, coughing, feeling faint, vomiting, extreme anxiety.
Question 3
Discuss the treatments for all aspects of the patient’s condition, including slowing the progress of the atherosclerosis, maintaining circulation in the leg, and treating complications.
Treating atherosclerosis includes lifestyle changes, such as weight management, exercise, and eating a healthy diet. Foods high in soluble fiber are great while decreasing consumption of saturated fats, sodium and alcohol. Medications can be used to prevent further buildup of plaques, antiplatelet and statins which help to lower cholesterol. Using ACE inhibitors will decrease BP as well. If medication and lifestyle changes do not work then patient will need surgery, CABG. Mr. Kelly should elevate the legs to decrease edema, as well as participate in some lifestyle changes. It is advisable that he should also quit smoking.
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