Prioritisation of Complex Patient Health Issues

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Part One

This essay takes into consideration a cardiac case scenario involving Mathew Cottrell, a 65-year-old male having a history of complex health issues. Mr. Mathew Cottrell presented in the emergency department early morning at 07:00 hours on 12th August 2020 as he was exhibiting elevated shortness of breath and chest stiffness and rigidity. Mr. Mathew Cottrell’s partner accompanies him to the hospital’s emergency department as he complains of the two above mentioned conditions. Mr. Mathew Cottrell has a past medical history comprising of the diagnosis of idiopathic (non-ischemic) Dilated Cardiomyopathy two years ago. According to the New York Heart Association (NYHA), idiopathic dilated cardiomyopathy is categorised as a class two heart condition and this function classification is widely utilised in practice as well as clinical studies.

 According to a study carried out by Stolfo et al. (2018), the health issues pertaining to idiopathic dilated cardiomyopathy were evaluated with arrhythmic risk stratification remaining a major concern for both patients and clinicians. Patients who are diagnosed with dilated cardiomyopathy mostly suffer from compromised and impaired left ventricular ejection and hence, leading to inadequate heart function (Stolfo et al. 2018). Furthermore, Mr. Mathew Cottrell also presents a past medical history of suffering from Hypertension for which he adheres to Metoprolol in order to counteract the effects of the prevailing medical condition. Apart from this, he also suffers from Type II Diabetes Mellitus and due to this, is advised to follow a stringent diet plan. Mr. Mathew Cottrell also adheres to drinking four to five bottles of wine in a week along with smoking a pack of cigarettes. 

Mr. Mathew Cottrell manages a wine vineyard and lives with his wife and son in the south coast. Initially, when Mr. Mathew was admitted to the emergency department in the morning, he presented to have been suffering from tachycardia, chest tightness, hypertension, difficulty in breathing and swelling in ankles up till the knee joints. However, after the three tests including, electrocardiogram, echocardiogram and chest x-ray (CXR) were performed on Mr. Mathew Cottrell, additional medical conditions were observed. Hence, the three major health problems that Mr. Mathew Cottrell is suffering from include hypertrophy in the left ventricle with no variations in the ST segment as exhibited by the electrocardiography examination and hence, there is a risk for arrhythmic stratification. Furthermore, the echocardiogram showed that there was substantial reduction in the fraction of the blood ejected from the heart ventricles thereby exhibiting a potential for heart failure and the chest x-ray (CXR) demonstrated that there was congestion in the bilateral lower lobe and that there was considerable enlargement in the size of the heart hence, again serving as a risk for myocardial infarction. 

Thus, these are the three cardiac related health issues which constitute a core part of the cardiac case study given and are linked towards Mr. Mathews past diagnosis of idiopathic (non-ischemic) dilated cardiomyopathy and also serve as the basis for prioritisation of complex patient health issues. According to a study carried out by Li et al. (2018), a comparison between alcoholic cardiomyopathy and idiopathic dilated cardiomyopathy was drawn. Samples from six regions of the explanted heart were acquired including those from left and right atrium as well as the right and the left ventricle. In both the samples, significant fibrosis in the myocardium was observed and hence, this exhibits the negative impact exerted on the heart due to intake of alcoholic substances (Li et al. 2018). This also explains why Mr. Mathew Cottrell is experiencing conditions such as chest stiffness and shortness of breath as it is evident from his medical background that he is a regular drinker adhering to consumption of four to five bottles of wine per week.

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