What is your diagnosis for the patient?
The diagnosis for Joan is Cardiogenic Pulmonary Edema. According to The Gale Encyclopedia of Medicine, Pulmonary Edema is a condition in which fluid builds up in the lungs which is most likely due to the left ventricle not pumping adequately (Milto, 2011).
To start off, Joan’s history shows a couple of signs that lead to pulmonary edema that she exhibits. One of the main things she had was dyspnea on exertion, or shortness of breath and also some lightheadedness with coughing paroxysms. These are some of the signs and symptoms that doctors look into before diagnosing a patient. Another key factor in this possible observation is knowing the activities the patient used to do. It wasn’t a sudden series of trouble breathing. Joan was a very athletic person, but at the same time in her patient history, it shows that she has a history of smoking half a pack of cigarettes a day. She did this for 16 years, and since she’s 38 currently, it shows that she started when she was in her early 20’s. When an individual smokes, it can lead to respiratory problems. And studies by Her smoking might have not caused edema directly, but it did lead to many other symptoms like the coughing paroxysms. Lorraine Wade has evaluated that edema in the alveoli causes dyspnea and tachypnea.
To explain how she got swelling in her lower extremities, we should explain what edema is and what causes edema. Edema is simply swelling of fluid in certain parts of your body. Edema builds up these liquids and makes one appear overweight, but weight doesn’t equate to edema in this situation. Pulmonary edema is said to also be tied to Congestive Heart Failure, which has very similar symptoms of edema in the lower extremities and possible side effects. Congestive heart failure is a condition that shows the heart isn’t pumping blood well. The reason why I am bringing up CHF and how it connects to Pulmonary Edema is because of the way Joan’s heart was acting during her lab test. It said that she had a grade 2/6 systolic murmur in her right sternal area. When a murmur is heard in the heart, that means that the heart isn’t pumping as loud as it should. Wade predicts that patients with cardiogenic pulmonary edema to also have some abnormal cardiac examinations (2005).
Joan’s physical exam and results also state that her High Resolution CT showed bilateral atelectasis and pleural effusions at the lung base. Bilateral means two sides and atelectasis is an issue when your lungs collapse. A possible reason for Joan to be experiencing this could be because of the retention of fluid in her pleural cavity. During normal exchange due to diffusion, no fluid should be able to enter into the alveolar interstitial spaces because inside the alveoli walls which contain simple squamous epithelial tissue, there are tight junctions. It is simple squamous so that there can be room for gas exchange. But in the capillary endothelial cells, which are on the alveoli, there are small gap junctions in between them. If any interstitial fluid that flows from those capillaries goes into the interstitial space of the alveolus, the lymphatic system kicks in and removes that fluid from there and returns it to the system circulation (Ware, 2005). According to Lorraine Ware in the Journal, the hydrostatic force for fluid filtration is approximately equal to hydrostatic pressure in capillaries. When that increases, it causes an increased transvascular fluid filtration which Ware believes is one of the causes for acute cardiogenic pulmonary edema (2005). When the fluid retention in the lungs increase, this can cause the weight and pressure in lungs to increase.
What is the cause for the patient’s shortness of breath?
Joan’s Physical examination states that she had a palpable venous cord along the anterior surface of her neck that extends along the superior border of her clavicle bone. When your veins are noticeable palpable, that means they are very visible to the touch. According to Lorraine B. Ware from the New England Journal of Medicine, elevated neck veins could suggest elevated venous pressure (Ware 2005). If her neck is slightly elevated, most likely there is some sort of backup of fluid during exchange in the interstitial space. I bring back smoking because I believe smoking is tied to her respiratory response acting like it should. There are two ways the blood is pumped into heart via veins. Using respiration via diaphragm and lungs, and skeletal muscles. Because she is complaining of shortness of breath, most likely, the respiratory pump isn't functioning as it should. When she is breathing, the respiratory pump is supposed to help draw blood and push it to where it should go. But because she has poor inspiratory effort, according to her lab results, this could possibly cause some backup or for fluid to not fully pumped through the venous valves, and not enough blood is pumping through the heart. So because of that, not enough blood is going through pulmonary circuit for gas exchange. This could explain why she is having trouble breathing. In addition to the retention of water in her lungs which causes her to cough and gasp for breath, due to her smoking cigarettes for a long time.
Would an echocardiogram be indicated for this patient and what information would be gained?
I believe that an echocardiogram would be indicated for the patient. According to Jessica Powell, she and her other partners believe that when doing an echocardiogram for a patient with acute pulmonary edema, they will be able to receive diagnostic test results for their renal functions, full blood count, and blood glucose concentration and troponin (2011). In her lab results, Joan’s Hemoglobin count was 11.0 g/dL which is a little bit of a low number. The standard should be about 12 to 15.5. Her white blood cell count was 15,600/mm3 and platelet count was 49,000/mm^3. If she were to constantly check her blood count, it can give a doctor an idea on what could be causing her immune system to be acting up and causing her to have shortness of breath. When these numbers are shown and also with the tests for her renals, it can give the doctor the proper treatment. Most likely to drink more water and pee out the fluid in hopes to reduce the swelling associated with edema.
This patient experienced right upper extremity swelling. Give a solid anatomical explanation for this finding in the patient’s examination. In addition, give a thorough anatomical description of the vessels involved.
I briefly explained how the venous valves get some assistance from the respiratory pump to push blood towards the heart with the help of the venous valves. I mentioned that the venous valves prevents backup. In the capillaries, they do an exchange of fluid and capillaries are located in many parts of the body. If the right side of her body is swelling and not the left, it could be associated with some sort of heart problem on the right side, which pumps deoxygenated blood into the heart via the veins. I mentioned before how the venous return can be delayed if there is not enough help from the respiratory pump. So because of that, the veins don’t get enough pressure anyway to pump blood. This causes buildup and when this happens, in the capillaries, they are performing hydrostatic pressure which pushes fluid out of vessels. Her lymph nodes are fine but due to the pressure being low anyway, the osmotic pressure is also delayed which causes the fluid flowing back to the vessels via osmotic pressure is also slow. This causes the interstitial space to be filled with fluid and causes edema. That grade 2/6 murmur that was heard was an abnormal most likely due to the buildup of fluid in that area. Which is causing the edema to occur.