Cardiovascular Disease in the Elderly

Ageing is the condition in which changes along with functional and structural features of the body in an individual is seen with time as the body loses the ability to replace and repair damaged cells. In this assignment, the case study of a patient named Stella is to be analysed who is above 65 years of age and is found to be suffering from cardiovascular disease. In the process, the way specific cardiovascular disease influences the homeostasis of the body with ageing is to be explained. Further, the pathophysiological, psychological and sociological impact of the specified cardiovascular disease is to be explained. A pharmacological or therapeutic intervention for the condition is to be explained.

The case study informs that Stella is diagnosed with coronary heart disease (CHD) which is evident as she is showing all the symptoms regarding the disease such as chest pain, sudden weakness, confusion and numbness in hands and feet. The numbness along with chest pain is faced in CHD because the deposition of plaque in the blood vessels that restricts proper blood flow to the heart and other parts of the body (Anderson et al. 2016). The CHD is the most common cardiovascular disease among the people living in the UK. This is evident as statistics reveal that nearly 2.3 million people are living with CHD which is nearly 1.5 million men and 0.63 million women in the UK (bhf.org.uk, 2018). In addition, it is mentioned that nearly 64,000 people in the UK die each year as a result of CHD which is on an average of 160 individuals each day. Out of the deaths as a result of CHD, it is found that 23,000 of the people are above the age of 75 years (bhf.org.uk, 2018).

The coronary artery disease disrupts the homeostasis of the body creating nrrowin of blood vessels leading the individual face complications in heart. As mentioned by Hasib et al. (2016), homeostasis is referred to as the relative state of body equilibrium between interdependent elements related to the physiological processes. The maintenance of proper homeostasis in the body is required to deliver adequate amount of oxygen and nutrients in the body along with normal pH and temperature is maintained. As argued by Head et al. (2017), presence of coronary artery disease which creates blockage of the arteries restricts blood flow in the arteries that deliver blood to the body which in turn prevents adequate oxygen-rich blood to be sent to the organs and tissues. This leads to disrupt the homeostasis of the body as the lack of oxygen and nutrients makes the tissues and organs to act abnormally creates weakness and pain.

The ageing of the individuals also disrupts the homeostasis of the body due which older people are more prone to develop coronary artery disease. As mentioned by Pyšná et al. (2019), ageing of individuals leads the BM-derived progenitor cells to become impaired which are responsible to repair the damaged arteries caused by high lipid concentration in the body so that homeostasis can be maintained. Thus, this incapability of being repair leads the older individuals to develop atherosclerotic lesions making them face coronary heart diseases. In case of Stella, she is found to be 70 years and thus due to age-related issues her body homeostasis may be lost due to which the damaged arteries can no longer be repaired leading them to be narrowed in turn developing coronary artery disease. In another study by Head et al. (2017), it is informed that senescent cell accumulation with ageing which produces pro-inflammatory cytokines along with matrix metalloproteinases (MMPs) in the atherosclerotic sites leads to the development of atherosclerotic lesions. This, in turn, leads the arteries to lose their ability to repair and in turn restrict blood flow in the body making the individuals develop coronary heart disease.

The pathophysiology of coronary heart disease informs that deposition of cholesterol-rich deposits inside the wall of the arteries which are known as plaques leads to coronary artery disease and the condition is known as atherosclerosis. The study by Noble (2017) mentions that arteriosclerosis that leads to coronary heart disease initially beings with development of fatty streak that is accumulation of foam cells laden with lipid in the inner layer of the artery. The retention of lipid is the initial stage of the pathogenesis of atherosclerosis that is later followed by chronic inflammation near the susceptible sites in the major arterial walls which leads to fatty streaks. The fatty streaks get evolved to atherosclerotic plaques that are made up of mainly three components such as inflammatory cells, smooth muscle cells and fibrous connective tissues along with component of lipid (Yahagi et al. 2017).

The fatty streaks initially after development lead to attract the smooth muscles cells in the site where they are multiplied to initiate producing extracellular matrix which is made up of proteoglycan and collagen. This is the extracellular matrix which composes a large part of the atherosclerotic plaques in coronary heart disease (Badimon et al. 2017). The atherosclerotic plaques formation along with fatty streaks leads to the formation of fibrous plaques and the lesions initiate to bulge inside the walls of the arteries causing the luminal space to be narrowed (White, 2016). After this, the fibrous plaques is able to support itself and forms own vessels to provide blood in the process of angiogenesis. These plaques then initiate to calcify and the final plaque which is formed inside the arteries is made up of lipids and huge amount of necrotic dead cells leading individual to develop the coronary disease (Feng et al. 2016). In the case of Stella, it is seen that she is feeling numbness in hands and feet indicating formation of plaque in the arteries. This is evident as plaque formation blocks normal blood flow to the arms and legs which leads the individual to feel numbness (Conti, 2019).

The increased age of the individuals makes their heart to be enlarged slightly and the wall of the blood vessels to be thicker leading constricted blood flow throughout the body. This is evident as with ageing the senescent cells which are present in increased amount releases senescence-associated secretary phenotype (SASP) that are seen to propagate the formation of arteriosclerosis by promoting production of adhesion along with inflammatory factors (Childs et al. 2017). The individuals who smoke for longer time with ageing is found that their blood platelets become sticky which leads them to be clumped together to form clots. This clots block the passage of blood through the coronary arteries making the individuals faced CHD such as heart attack (Zhang and Yuan, 2016).

The coronary heart disease is seen to create impact in the psychological as well as sociological functioning of the individuals. As asserted by Dhar and Barton (2016), coronary heart disease (CHD) leads individuals to develop depression. This is because the diseased states make the people they are incapable to take their own care as well as the complication created as a result CHD in the body makes the people think would die eventually making them feel depressed. In case of Stella, it is seen that the fear of death due to her present condition of CHD has led her to be depressed. As criticised by Sin et al. (2016), presence of depression in CHD impacts the patients to face deteriorated cardiovascular events along with increased re-admission to the hospital as a result of relapse of the disease. This is because depression makes the patients suffering from CHD show improper response to the treatment for the disease as well as they are found to avoid accepting proper pharmacological intervention required for the disease making their health to worsen.

The study by Palacios et al. (2018) informs that the presence of anxiety as a nature of psychological condition among CHD patients creates negative impact on the prognosis of the disease. In the case of Stella, it is seen that she is suffering from anxiety as she is becoming uncertain to proper care of her husband who is dependent on her due to her health condition. This is going to hinder her health condition in negative manner. As argued by Solorzano et al. (2019), emotional well-being of the carers is hindered apart from the patients while caring for the individuals with coronary heart disease. This is because the patients become burden of care on them and the carers such as the family members due to lack of understanding regarding the way to manage patients become anxious and stressed.

The psychological impact on the family as a result of presence of patients suffering from coronary heart disease is that it creates distress among them (Miyawaki et al. 2017). This is because the family members become anxious regarding health condition of the patient who is family member and lack of understanding regarding the way to care for them leads them to be distressed. It is evident as Douglas who is the only family member of Stella was found to be stressed knowing the health condition of his wife and failing to understand the way to support her condition. The family members suffer from depression with patients having coronary heart disease as they fear to lose them through death (Bhattacharyya et al. 2016). This is evident as Douglas is found also to be upset and distressed with the fear of losing his wife due to the disease.

The sociological impact of coronary heart disease of the patient is that it creates financial struggles for the family (Dhaliwal et al. 2017). This is because in case of Stella it is seen that her husband who is the sole earner of the family is retired and he is not more physically able to work properly to earn as a result ageing issues. Thus, in this condition, using money to avail treatment for CHD for Stella would create financial constraints for the family as they do not have any steady sources of income. As asserted by Elissa et al. (2018), lack of basic education and awareness regarding health issues makes individuals unable to understand when and which healthcare services are to be approached to ensure timely care is provided. In case of Stella and Douglas, it is seen that both are properly educated and have proper perception regarding the time and which healthcare to be approached as a result they are able to determine healthcare resources to be approached to ensure them better health. Therefore, social issue related to education regarding healthcare can be avoided in case of Stella and Douglas.

The prolonged smoking behaviour along with ageing has led coronary arteries of Stella to be blocked leading her to face coronary heart disease. It is found that Stella is facing chest pain which is worsening with days and therefore immediate relief is to be provided. This is because chest pain due to blocked coronary arteries indicates the risk of having a heart attack which is often fatal (Head et al. 2017). The coronary artery by-pass surgery is not to be referred for Stella. This is because it is used when the heart muscles are found to be too weak and when the main artery which delivers blood to be heart is damaged along with many associated arteries (Cimen et al. 2019). Since the diagnosis of Stella through angiogram and Electrocardiogram informs that her pulmonary artery is not blocked and only few of the associate arteries are blocked, therefore the complex procedure for bypass surgery is not used. Thus, the pharmacological intervention which is effective in this case is angioplasty as it is going to provide immediate relief to Stella to live a healthy life as well as reducing risk for heart attack.

Angioplasty is referred to the medical procedure in which the blood flow towards the artery is restored by expanding the blocked arteries (Hamed et al. 2019). The angioplasty for Stella is to be performed under the supervision of a cardiologist and team of cardiovascular nurses in the operating room. In angioplasty, a stent that is placed ion collapsed form around a balloon at the catheter tip is properly directly into the artery which is blocked. In the blocked position, the balloon is inflated and the wire-like stent in the form spring expands as well as locked within the walls of the arteries so that it permanently extends the blood vessels to allow smooth flow of blood. After the placement of the stent, the balloon is deflated to be removed and X-ray images are taken to ensure the blocked arteries are properly widened to ensure normal blood flow (Hamed et al. 2019).

The advantage of using angioplasty is that it helps in saving the individual’s life by reducing muscle damage to be caused by heart attack (Singh et al. 2019). This is because the blood flow is restored in the body and homeostasis is reached allowing the organs and tissues to have required amount of nutrients and oxygen from the blood. Thus, the adoption of the treatment is able to avoid damage to the heart muscles of Stella as well as avoid the risk of heart attack. As commented by Singh et al. (2019), angioplasty is beneficial as it helps to reduce symptoms related to coronary heart disease such as pain in the chest, fatigue and shortness of breath. Thus, medical intervention is advantageous for Stella to offer her immediate relief from her deteriorated health condition. As argued by Mu et al. (2016), the use of angioplasty in the treatment of coronary artery disease creates risk of internal bleeding. This is because during administration of the catheter inside the arteries the walls of the arteries may be damaged in turn complicating the health condition of Stella.

The benefit of using angioplasty in coronary artery disease is that it restores proper flow of blood to be brain as well as hands and feet (Singh et al. 2019). This is essential for Stella as it would resolve her numbness feeling in the arms and legs allowing her to properly perform her daily chores. As criticised by Mu et al. (2016), the limitation of angioplasty is that it may lead to the development of scar tissue within the stent. Thus, it creates risk for Stella to need repeated procedure of the surgery. The angioplasty creates risk of formation of blood clot inside the stent that would require immediate medical intervention. In addition, the patients may show allergic reaction to the stent inserted inside arteries as a risk related to angioplasty (Torkan et al. 2019). Therefore, the physicians are required to ensure proper health check-up of Stella to understand whether or not the material used in the stent during angioplasty would affect her healthy condition due to allergic reaction. After the surgery, Stella requires to maintain a healthy diet as well as quit smoking. This is because smoking leads to damage the arteries due to the presence of harmful substances in the smoke such as nicotine, carbon monoxide and others (Torkan et al. 2019). The antiplatelet medication such as clopidogrel, ticagrelor, prasugrel and others are often provided to the patients after angioplasty so that blood clots can be avoided (Goldstein et al. 2016). Thus, Stella is required to ensure proper dosages of the medication are taken so to avoid further risk.

The Rolfe’s reflective model is used to reflect regarding my experience in the patchwork text framework. The Rolfe’s model includes three steps that are What?, So what? and Now What? (Nicol vand Dosser, 2016). In the “What?” phase, the situation is described (Joyce-McCoach and Smith, 2016). In doing the patchwork text framework, I was initially confused regarding the way facts are to be presented. This led me to face hindrance in understanding the way pathophisiology of the disease and psycological impact of the disease of the mentioned patient on the family to be described. However, with the help of the tutor and further analysis of the lecture notes I was able to understand the way the pathchwork is to be presented. In the “so what?” phase, the learning is discussed (Joyce-McCoach and Smith, 2016). In this phase, I learned that I lack effective ability to determine the way facts are to be described and presented in proper format without assistance. However, I also determined that I have effective communication and analytical skills due to which I was able to resolve my complications. In the “now what?” phase, the future actions are mentioned (Joyce-McCoach and Smith, 2016). In this phase, I determined that in future I am going to work work on my descriptive skills to understand way to present information in proper format.

The above discussion informs that Stella is suffering from coronary heart disease. The pathophysiology of coronary heart disease informs that due to plaque formation proper amount of blood cannot reach the heart and the rest of the body which leads to raise coronary artery disease. The psychological effects of the disease include anxiety depression, stress and others. Moreover, the presence of CHD among patients makes their family members depressed and upset as they are unable to understand the way to care for the patients as well as fear losing them due to fatal consequences related with the disease. The pharmacological intervention for coronary disease faced by Stella involves angioplasty as it would offer her immediately relief and avoid heart attack.

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