Question

A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF)

In your Case Study Analysis related to the scenario provided, explain the following:

1. The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.

2. Any racial/ethnic variables that may impact physiological functioning.

3. How these processes interact to affect the patient.

Answer 1

Shortness of breath, pleuritic chest pain and palpitations ( Rapid heart beats) Are symptoms of cardiovascular and pulmonary diseases.

1.Patient presenting symptoms suggest cardiopulmonary pathophysiological process. EKG result of T wave inversion in the right pericardial leads (V1-4) ± the inferior leads(2,3 aVf) present in Pulmonary embolism ,a type of venous thromboemolism mainly occur to postoperative patients. It is a condition where blood clots from most often in the deep veins and travels in the circulation,lodging in the lungs it leads to pulmonary embolism. Causes for pulmonary embolism are ,surgery, cancer, immobilization and hospitalization.

Patient history of surgery, and its cause of knee replacement leads to immobilization,and hospitalization ,and his finding and presenting symptoms suggest that patient had pulmonary embolism.

2.Venous thromboembolism varies significantly among different ethnic and racial groups,the genetic,physiological and clinical basis for these differences remain largely undefined.African-American patients have a significantly high rates of incident venous thromboembolism,particularly following exposure to provoking risk factors. African Americans are more likely to be diagnosed with pulmonary embolism,these incidents are very less in Asian/Pacific Icelanders.

3. Pulmonary embolism occur when deep veins thrombi separate and enters into pulmonary circulation. It leads to pulmonary occlusion and causes impaired gaseous exchange.Larger emboli wedges in the main pulmonary artery,smaller embolism occlude the peripheral arteries,it leads to pulmonary infarction,manifested with intra alveolar hemorrhage.Lower lobe of lungs are more frequently affected with pulmonary embolism.Obstruction of pulmonary artery by emboli,create dead space ventilation as alveolar ventilation exceeded pulmonary capillary blood flow ,increase vascular resistance. It leads to release of serotonin and thrombooxane from activated platelets and leads to vasoconstriction leading to right ventricular failure. It leads to hypo tension, syncope,electromechanical dissociation or sudden death.