Question

case study

Ahmad is a 74 year old male patient who has been admitted to the medical ward with acute fatigue, severe shortness, orthopnea and productive cough with hemoptysis. Ahmad's health conditions started to deteriorate since he had an acute myocardial infarction (MI) five years ago. He also presented with lower limbs edema including ankles and feet. According to Ahmad, the edema has started about 1 year since he had the MI. Ahmad also has a history of hypertension and type 2 diabetes mellitus, which have been controlled with oral pharmacological agents. Ahmad was only discharged from hospital last week after he had been treated from a severe chest infection. Ahmad used to smoke one pack per day for 40 years but has given it up six years ago. Ahmad’s vitals were as follows: BP 90/50 mmHg, HR 95 beats/m, RR 28 breaths/m, temperature 38c and SpO2 85% (on room air). Ahmad was reviewed by the doctor and blood samples were taken and sent to the lab for CBC analysis. Ahmed also had a chest x-ray and was sent for an Echocardiogram. The blood results showed: WBC 12,500, platelets 350, 000, and Hgb 8 g/dl. Chest x-ray results revealed pulmonary edema with right lower lobe consolidation and a small pleural effusion in the right lower lobe. During the physical examination, the lung auscultation revealed diminished breath sounds in the right lower lobe and absence of breath sounds at the base with wheezes in the bronchial area.

Q1. Discuss why Ahmad has shortness of breath and how this impaired the ventilation and perfusion process?

Answer 1

Answer: The shortness of the breath occurs due to the inflammation in the airways of the lungs. In the diagnosis, it is mentioned that the patient is having diminished breath sounds in the right lower lobe and absence of breath sounds at the base with wheezes in the bronchial area. This causes impaired gas exchange as sufficient amount of oxygen couldn't reach to the lungs. Hence this causes breath shortness. Patient has already suffered from myocardial infarction, hence the cardiac muscles have become weak. It requires more efforts to pump the blood. But due to insufficient amount of oxygen, the blood supply also gets imbalanced. Both are affected that is the alveolar blood flow and the oxygen.