NURS 6501 Week 3 Assignment Cardiovascular Disorders

Pathophysiology of Primary Diagnosis

Aortic aneurysm develops because structural deterioration within the arterial wall makes a specific area of the aorta weaken and expand (Gao et al., 2023). Progressive vessel dilation occurs due to sustained vessel stress which results in weakening of the material structure. The main cause of aortic aneurysm occurs through the deterioration of smooth muscle and elastic fibers found in the middle layer of the vessel wall called the tunica media. The arterial wall subjected to lipid and plaque accumulation in atherosclerosis develops inflammatory responses which diminishes the structural proteins elastin and collagen. When elasticity decreases in the aortic wall it becomes more likely for the vessel to expand when the body experiences blood pressure. Progressive aneurysm growth leads to the thinning of the vessel wall which raises the danger of either vessel rupture or dissection.

Causes 

Risk Factors (genetic/ethnic/physical)

• Aortic Wall Degeneration: Progressive deterioration of tunica media results from elastin and collagen destruction which reduces the vessel resistance to standard blood pressure.
• Chronic Inflammation: The sustained presence of inflammation resulting from immune system operations and infections and autoimmune disorders causes both structural damage and wall weakening of the aorta (Yuan et al., 2021).
• Atherosclerosis: The presence of atherosclerosis causes plaque formation in aortic walls that leads to vessel wall stiffness and reduced oxygen flow which then results in weakened walls that demonstrate bulges.
• Genetic Disorders: Aorta damage occurs in genetic disorders such as Marfan syndrome, Ehlers-Danlos syndrome along with Loeys-Dietz syndrome because these disorders affect connective tissue integrity which makes the aorta vulnerable to aneurysm and dilation development (Soto et al., 2021).
• Mycotic Aneurysms: Mycotic Aneurysm develops from bacterial or fungal infections including tuberculosis and syphilis and endocarditis which destroy the aortic wall tissue.

Genetic Risk Factors

• Marfan Syndrome represents a hereditary condition which damages connective tissue structures and causes weakened aortic walls that raise the possibility of aneurysms developing (Zeigler et al., 2021).
• Ehlers-Danlos Syndrome (Vascular Type) is a collagen disease that manifests through weak blood vessels leading to potentially dangerous aortic aneurysm manifestations and dissections.

Ethnic Risk Factors

• Scientific research indicates that European descendants experience abdominal aortic aneurysm (AAA) at higher rates than different ethnic identities (Peypoch et al., 2020).
• An aortic aneurysm in any first-degree relative dramatically elevates the chances of the condition in any person of any ethnicity.

Physical Risk Factors

• Prolonged high blood pressure damages the aortic wall by placing ongoing pressure on it thus speeding up the tissue deterioration and boosting the chance of an aneurysm.
• The process of atherosclerosis results when fatty substances clump inside the artery walls and create hard vessels that become weak thus leading to aneurysm formation.

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system?  Complications?

• Most aortic aneurysms remain without noticeable symptoms prior to reaching a bigger size or when they rupture.
• A pulsating abdominal mass exists as a vital sign used to detect abdominal aortic aneurysm in people (AAA) (Accarino et al., 2022).
• The painful sensation of deep aching in the chest area or between shoulder blades and upper back falls under the description of thoracic aortic aneurysm (TAA).
• The pressure from a thoracic aneurysm against airway and esophagus structures causes breathing problems along with hoarseness and swallowing difficulties.
• The life-threatening condition shows as intense chest back or abdominal tearing pain which produces rapid heart rate and shock together with dizziness.

• Cardiovascular System: Aortic aneurysms create weaknesses in the largest body artery which decreases blood circulation throughout the system. Internal bleeding caused by aneurysm rupture would result in severe hypotension and eventually lead to cardiovascular collapse (Harjola et al., 2020). Thrombus formation within aneurysms raises the danger of embolism that blocks smaller arteries causing tissue death through ischemia.
• Respiratory System: When thoracic aortic aneurysms compress either the trachea or bronchi it causes breathing difficulties accompanied by wheezing in addition to chronic coughing. When an aneurysm applies pressure on the recurrent laryngeal nerve it creates hoarseness. The ruptured aneurysm within the chest cavity results in hemothorax which blocks oxygen-exchange ability by forming fluid around the lungs.
• Nervous System: When aneurysms interrupt blood circulation to the brain they elevate the chances of a stroke occurring. A blood clot from the aneurysm which enters cerebral arteries result in ischemic stroke which then produces neurological impairments including weakness or speech difficulties and paralysis (Barbato et al., 2022). The rupture of an aneurysm produces severe hypotension which triggers worldwide hypoxia and subsequently causes brain damage.
• Renal System: Reduced blood flow due to an aortic aneurysm can lead to kidney ischemia, increasing the risk of renal failure. If emboli from the aneurysm obstruct the renal arteries, it may cause hypertension and decreased kidney function, leading to fluid and electrolyte imbalances.

• Aortic Dissection appears as a lethal situation that develops when blood flows between layers of the aortic wall after a wall tear produces severe intense chest or back pain. The distinguishing symptoms in such situations include unequal pulses and differing blood pressure readings between the arms and shoulders.
• Myocardial Infarction produces chest pain which extends toward the back, jaw, or arm together with breathlessness and blood pressure decline. An MI differs from an aneurysm because artery blockage triggers MI incidents which result in ECG changes and elevated cardiac enzymes in patients (Ghazinour et al., 2024).
• The medical emergency of Pulmonary Embolism (PE) brings sudden chest pain combined with shortness of breath and hypotensive conditions that duplicate aneurysm rupture symptoms. PE occurs when clots affect the lungs but medical professionals can identify the condition through D-dimer testing combined with CT pulmonary angiography and arterial blood gas analysis.
• Extremely painful epigastric or abdominal discomfort which extends to the back might suggest a perforated peptic ulcer just like an aneurysm rupture. Adults who have experienced ulcers or took NSAIDs may develop this condition while an abdominal X-ray confirms the free air under the diaphragm.
• Gallbladder disease includes both cholecystitis along with biliary colic and causes right upper quadrant or epigastric pain which may spread to the back along with nausea and vomiting. A gallbladder-triggered condition exhibits internal gallbladder inflammation during ultrasound imaging following fatty food consumption.

• Computed Tomography Angiography (CTA) functions as the highest standard for diagnosing aortic aneurysms while defining overall size and positioning and estimating potential rupture risks (Narula et al., 2021). CTA scans support proper diagnosis between pulmonary embolism and aortic dissection as well as aortic aneurysms.
• The ultrasound examination stands as the initial method to detect abdominal aortic aneurysms for symptomless patients who exhibit risk characteristics.
• The chest X-ray sometimes shows a widened mediastinum when patients have thoracic aortic aneurysm or aortic dissection but X-rays cannot provide definitive proof. These tests enable medical staff to eliminate pulmonary infection together with lung diseases.
• The electrocardiogram reveals cardiovascular injuries through its detection of ST-segment alterations which help doctors distinguish between myocardial infarction.
• Medical professionals order cardiac enzyme blood tests which contain troponin and CK-MB because these enzymes confirm heart muscle damage in suspected heart attack cases (Ion et al., 2021).
• Elevated D-dimer results indicate pulmonary embolism or aortic dissection thus doctors need to perform CTA and V/Q scan for further inspection.
• A Complete Blood Count provides information about anemia that may develop from aortic aneurysm rupture and also reveals infection-related changes in leukocyte levels.
• The Coagulation Panel that includes measurements of PT PTT and INR determines the blood clotting capabilities of patients who require analysis of bleeding conditions or anticoagulation therapy monitoring.
• Laboratory tests for Liver Function and the assessment of Amylase/Lipase levels help eliminate pancreatic or gallbladder disorders when epigastric pain shows up.

Medical Management

The treatment plan for small aneurysms that show no symptoms includes only surveillance for both male patients and female patients with diameter measurements below 5.5 cm for men and 5.0 cm for women. Blood pressure control stands as the most important treatment approach which may involve daily beta-blocker doses at 50-100 mg of metoprolol combined with daily ACE inhibitor doses ranging from 10 to 40 mg of lisinopril to lower aortic wall tension (Gao et al., 2023). Patients should take atorvastatin at 40-80 mg daily dose to treat atherosclerosis and prevent damage to vessels. Patients must stop smoking while controlling their cholesterol levels as physicians must perform CT or ultrasound examinations every 6-12 months to track aneurysm enlargement.

Surgical Intervention

Medical teams should plan aortic surgery when aneurysm sizes reach 5.5 cm or big growth (>0.5 cm within 6 months) happens or if it causes symptoms that affect health. Surgical treatment of the affected area requires completely replacing the damaged section with synthetic material. Endovascular Aneurysm Repair (EVAR) is a less invasive procedure using a stent graft to reinforce the aorta and is preferred in high-risk surgical patients. Emergency surgery is required for ruptured aneurysms (Aljabri et al., 2024).

Referrals

A vascular surgeon or cardiothoracic surgeon needs to conduct surgical evaluations. Healthcare professionals from the cardiology specialty should evaluate blood pressure and lipid levels with patients. Patients requiring genetic assessment of potential causes need doctors specializing in hereditary issues. Consultations with pulmonologists or gastroenterologists must occur in cases where aortic aneurysms compress respiratory or digestive organs leading to complications.

Lifestyle Modifications & Follow-Up

The patient needs to follow a low-sodium heart-healthy diet while performing low-impact exercise and abstaining from heavy lifting to protect their aortic wall from strain. The treatment requires frequent imaging checks through ultrasound or CT scans as well as regular medicine dose adjustments. The treatment requires that patients receive education regarding how to detect aortic aneurysm rupture signs which include severe immediate pain along with dizziness and low blood pressure.