Scope of Pathophysiology

Chronic cardiovascular disease such as congestive heart failure, cardiac arrhythmias and coronary artery disease and Chronic obstructive pulmonary disease (COPD) have a significant influence on one another this coupled with systemic inflammation has been considered as the primary linkage between most of these heart illnesses (Barr, 2010). Airflow limitation or impaired ventilation has been known to affect how the lungs work about dynamic and static hyperinflation mostly in persons with pulmonary emphysema which eventually could influence the performance of the cardiac system (Barr, 2010). Irrespective of the damage to the lungs, skeletal mass depletion also has a significant role in the cardiovascular functions in patients with pulmonary emphysema. 

The need for taking the medication in this patient should be one of the major concerns or the primary responsibility that should be undertaken. The need to take medicine is to ensure that there is no reoccurrence of the heart attack or even other cardiac conditions. It is essential also to emphasise that the medication will make the patient much healthier. It is also advisable for the patient to get counselling on the issue so that they can be able to reduce stress or even to be able to avoid Post Traumatic Stress Disorder after this ordeal (Ahmed, 2010). This is also the point at which other professionals are brought into the discussion because there is now the presence of another physician in the form of a psychiatrist.

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Gastric Ulcer

The factors contributing to this patient’s condition is the use of Aspirin, which she uses to control her headaches. The use of Aspirin and Ibuprofen has been known to enhance Gastric ulcer. This is also further elevated by smoking and drinking, which the patient does slowly.

These factors have led to the patient’s condition getting much worse, and the fact that she is taking Aspirin every few hours escalates the epigastric pain (Peleg, 1986). It is also indicative that the patient does not live a healthy lifestyle, mostly by what she eats and consumes. This has led to her condition worsening over time.

In this case, the synergism from the alcohol and the aspirin has had a higher combined effect on the patient. This is because the sum of the individual results of both the alcohol is much less than the combined amount of the two when together. This could be related to the patient getting the epigastric pain and the other symptoms (Peleg, 1986). On the other hand, antagonism could have led to her using Aspirin every few hours because the Aspirin’s work has been undercut bother factors and this is why her headaches do not go away (Peleg, 1986). This is because the combined effect of the two is smaller than the sum of the individual results when they are connected. Potentiation is derived from the word potent, and some drugs become much more potent or effective once they are combined with others, for example, one could take a cocktail of antibiotics because they can work much faster than taking one medicine (Peleg, 1986).

The bleeding of an ulcer is not accompanied with subtle effects because it is generally accompanied by blood passing into the intestine, vomiting of blood and once the blood is digested, it comes out as black, tarry stool as showcased by our patient (Peleg, 1986). This situation has to be treated immediately by having an endoscopy done after which cauterization or burning of the blood vessel should be done (Peleg, 1986).

Several issues are related to patient compliance, and medical advice should not be taken lightly, especially from a medical practitioner. In this case, the condition of the patient has continued to worsen despite being advised against a poor lifestyle that the patient is exposed to day by day.

The doctor is responsible for the well-being of the patient, and they must ensure that the patient does not go against their wishes. This is because it could lead to the death of the patient eventually. This is an issue that cannot be taken lightly because the patient can be able to comply with the advice of their doctor, and this can be done by even taking drastic measures. In this case, the patient could try and join a support group to help her deal with her heavy intake of alcohol. If she does not adhere to the advice, there would be no point in treating this patient because her health will always be compromised. 

Inflammation and Healing-Fracture and Swelling

There are several causes of pain and swelling, and they can manifest itself differently in people. In this case, it could be posterior tibial tendonitis. This is due to the nature of her injury, which has been caused by a fall which consequentially causes inflammation as indicated by the diagnosis (Rowbotham, 2009). The patient despite having foot pain and swelling should expect flattening of the foot, soreness inside of the foot arch, back of Ankle Pain and worsening of the foot pain when walking or even running (Witmer, 2016). As a measure to begin the recovery process, the patient should expect to be braced, immobilization, Orthotics or Steroid injections to help with her recovery process. However, immobilizing the foot could be her best option for recovery.

The rationale behind immobilizing the patient’s foot is to try and maintain the realignment of a bone; this process should be long enough to ensure that the healing process is initiated and that there is progress in the healing process. Immobilization will be determined by the nature of the fracture, and there are different options of immobilization for the patient, including screws, casts, braces, wires (Marshall, 2016). In this case, the patient will have a cast around her ankle area and probably from her knee down to her toes. 

There could be a lymphatic blockage that could occur from Edema this happens once the plasma proteins which leak into the interstitium have no other way to be removed. This could be caused by immobilization of the area. There are two types of Edema, namely extracellular and intracellular Edema (Rowbotham, 2009). There are different causes for both these types of Edema, and they range from inadequate nutrition to the cells in Intracellular Edema to abnormal leakage of fluid from the plasma across the capillaries in extracellular Edema (Barron, 2009). This is something that should be looked at from time to time once she has her cast checked.

Fatigue, Anorexia and Low-grade fever could be caused by inflammation of the area that has been injured. However, the low-grade fever could be an indication that the body could be trying to heal itself and this could mean that most of the nutrients are being used up in the healing process (Silas, 2016). At times during this process, most people are known to add weight because they eat more than they usually do try to make up for the nutrients which are being used up by the healing process.


Lifestyle change and adhering to doctor’s advice is vital for anyone who intends on becoming healthy and once these instructions are given it is essential to heed to the doctor’s instructions to have better and improved health. Some of the people mentioned above have not been able to heed to the doctor’s wishes to have improved health, and this has led to their health deteriorating.


Barr R.G., Bluemke D.A, Ahmed et al. (2010) “Percent emphysema, airflow obstruction, and impaired left ventricular filling,” The New England Journal of Medicine, vol. 362, no. 3, pp. 217–227. 

Peleg, M, (1986) “Rheological Characteristics of Selected Food Gum Mixtures in Solution,” Journal of Texture Studies, 17, pp. 61–70.

Rowbotham, E; Barron D (2009). “Radiology of fracture complications”. Orthopaedics and Trauma. 23 (1): 52–60.Witmer, D. K., Silas T, Bruce D. (2016). “Emergency Care of Musculoskeletal Injuries”. In Townsend, Courtney M.; Beauchamp, R. Daniel; Evers, B. Mark; Mattox, Kenneth L. (eds.). Sabiston Textbook of Surgery (20th ed.). Elsevier. pp. 462–504.

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