Sometimes in this landscape or world of healthcare, there are some cases which often comes with many challenges, which requires a in depth assessment and understanding of the condition of patient which are connected internally. There was a once case which covered COPD or chronic obstructive pulmonary diseases, MI or myocardial infarction and subsequent hemiparesis. This case is a very much example of complexities of healthcare outside of the book how to manual.

Understanding the Diseases

To understand this case first we need to understand the conditions included in this case so we can learn about what is the root cause, symptoms, and how can we tailor a protocol which can help the patient with his life.

COPD – chronic obstructive pulmonary disease

So COPD is a respiratory condition which means it revolves around lungs and your respiratory systems. To understand the conditions first assume that lungs which are our organs which helps us in breathing are like balloons, so when someone breaths in balloon gets filled with air and gets inflated. The balloon has a tube like structure by which we are filling the air into balloon. So in COPD the tube which is being used as a track for filling air and carry it out becomes very narrow and sometimes even blocked, so because of the narrowing of tube someone is always feels like they are struggling to catch the breath. In this example tube of the balloon which we are using to get air in and out are in real life called airway. So in reality because of narrowing or blockage of the airway the COPD occurs.

But ever wonder why this happens? so the simple answer is things like smoking, pollution or inhaling toxic particles. Because of this things lungs gets irritated and after sometime the body reacts to it by inflammation and damage. It’s simple like when you try to blow up to many balloons your cheeks gets sore just like that this mechanism happens.

So when you have this condition you balloon are not filling air properly or in other words the lungs are not working as they should be. Someone with this condition will feel like breathlessness, coughing, cannot walk for prolong period of time or cannot even climb the stairs.

In other words COPD is a respiratory condition which is progressive and it is characterized by airflow limitation.

Myocardial infarction

Now let’s move to the other condition which is a cardiac condition means it revolves around our heart. So as we first did, let’s imagine that our heart is like a simple water pump, Just like a pump delivers water throughout the house, our heart delivers blood throughout the body, this process is done via pipes or arteries, so sometimes because of some conditions this pipes or arteries get clogged or if we don’t gave them enough attention they even can get blocked. So same as this if the arteries get blocked it can cause heart attack or in medical term they call it myocardial infarction.

If we need to simplify it we can try this; suppose someone is drinking something out of a cup using a thick straw let’s assume it’s a milkshake, if the straw is blocked by anything, he cannot suck up any more of his favorite drink, just like this happens in MI (myocardial infarction). a blockage occurs in one of our heart’s arteries, because of which our heart muscle cannot have the blood supply they needed. Also because of this blockage heart cannot have the enough blood to pump which makes us feel like we are having discomfort, someone is squeezing our heart out.

So in other word MI is cardiac condition which is also known as heart attack, is occurred due to insufficient blood supply to heart muscles.

Hemiparesis

Ok, as we’ve understand the basic definition of MI and COPD let’s move to the condition which can be caused by conditions like this. So suppose there is a house and it has a so many wires in it, which flows the electricity from main source to the devices which you’re using like microwave, refrigerator, fan, AC or any other devices. Just like this our body has a complex network that sends messages and receives it between different parts of our body.

Sometimes, as our electrical wires can have different problems like cutting of the wires, not a proper bond or plugging of wires or having any object which blocks the wires to flow electricity in our house flawlessly, because of this electricity cannot go through wires and our devices cannot functional properly, just like this our main power source for function or control is our brain, and the wires are our nerves. So when this nerves gets damaged pinched or there is problem in our control unit, our brain, our limbs cannot function properly.

How does MI and COPD can cause Hemiparesis?

But the question is how does respiratory and cardiac conditions like MI and COPD can cause this neurological condition ?, to understand let’s just take the last example, if there is a problem in the power source in our house or there is a blackout or there is problem in flow of electricity, our devices won’t function normally, just like this if there is COPD it can affect the gaseous exchange which can affect the oxygen amount which is there in blood also if there is a problem in the flow of electricity ( blood in our case ) it causes a problems in brain cells because of which there is a problem with sensations and movements of the limbs.

So if we talk in medical language, if a patient is suffering from COPD, he will have problem in respiration which causes the less oxygen in our blood because of which there can be no proper metabolism which cause fat deposition or any other condition which can end up to block the artery of the heart. So when this happens heart cannot pump the enough blood to brain which can cause damage in brain and it can result into neurological conditions like hemiparesis.

Understanding the reason behind this conditions

Pathophysiology of COPD

Chronic inflammation, remodeling of airway, alveolar destruction

So as we discussed earlier, COPD is a chronic inflammatory condition of airways. Prolong period of exposure to smoking, pollution forces body to react which ends up in inflammation of the airways, which results into cell damage and this causes the narrowing of the airway with reduced elasticity of the lung, and mucus production. Also it can cause alveolar destruction which can cause the reduction of the surface area which are there for gaseous exchange. This causes abnormal or impaired oxygenation and hyperinflatted lungs.

Pathophysiology of MI or myocardial infarction

Coronary artery occlusion & myocardial cell damage

Now, pathophysiology of MI circles around arteries, specifically coronary arteries. So when there is occlusion of the coronary artery because of the plaque or thrombus, it causes the disruption of the blood supply which can cause ischemia of the myocardial tissue.

This occlusion can also cause decrease oxygen which can damage the myocardium, which leads to release of troponin which is a cardiac biomarker.

Pathophysiology of hemiparesis

Cerebral hemisphere damage

Pathophysiology of hemiparesis is typically result of motor cortex or corticospinal tract damage which are present in brain which is a result of stroke, TBI or any other condition. This causes disturbance or disruption of transmission of the brain signals which causes weakness, sensory loss and many more symptoms

Signs, symptoms, causes and risk factors

After understanding what are these conditions and how are they caused?, let’s understand what are the signs, symptoms , causes and risk factors to be more cautious about this conditions

COPD (Chronic Obstructive Pulmonary Disease):

Symptoms:

• Persistent cough
• Shortness of breath, especially during physical activity
• Wheezing
• Frequent respiratory infections
• Fatigue

Causes:

• Smoking is the primary cause of COPD. However, exposure to air pollutants and genetic factors may also contribute.
• Over time, repeated exposure to irritants damages the lungs and airways, leading to inflammation and narrowing of the air passages.

Early Signs:

• Mild shortness of breath, especially during exertion
• Occasional cough with mucus production
• Feeling tired more quickly than usual during physical activities

Risk Factors:

• Smoking, including secondhand smoke exposure
• Occupational exposure to dust, chemicals, or fumes
• Long-term exposure to indoor and outdoor air pollution
• Genetic predisposition

MI (Myocardial Infarction, commonly known as a heart attack):

Symptoms:

• Chest pain or discomfort, often described as pressure, squeezing, or tightness
• Pain or discomfort in the arms, back, neck, jaw, or stomach
• Shortness of breath
• Nausea, vomiting, or lightheadedness
• Cold sweats

Causes:

• MI occurs when there is a blockage in one or more of the coronary arteries, which supply oxygen-rich blood to the heart muscle.
• The blockage is usually caused by the buildup of plaque (atherosclerosis) in the arteries. In some cases, a plaque may rupture, leading to the formation of a blood clot that blocks the artery.

Early Signs:

• Chest discomfort or mild pain that comes and goes
• Shortness of breath, especially during exertion
• Feeling unusually tired or weak

Risk Factors:

• Smoking
• High blood pressure
• High cholesterol levels
• Diabetes
• Family history of heart disease
• Sedentary lifestyle
• Poor diet

Hemiparesis:

Symptoms:

• Weakness or paralysis on one side of the body, often affecting the arm, leg, and face
• Difficulty with balance and coordination
• Difficulty with fine motor skills, such as grasping objects or writing

Causes:

• Hemiparesis is most commonly caused by a stroke, which occurs when there is a blockage or rupture of a blood vessel in the brain, leading to brain tissue damage.
• Other causes include traumatic brain injury, brain tumors, and neurological disorders such as multiple sclerosis.

Early Signs:

• Sudden weakness or numbness on one side of the body
• Difficulty speaking or understanding speech
• Sudden onset of confusion or trouble with vision

Risk Factors:

• High blood pressure
• Diabetes
• Smoking
• High cholesterol levels
• Sedentary lifestyle
• Family history of stroke or cardiovascular disease

Also read : Down Syndrome: A Holistic Introduction

Diagnosis and investigations

So, now question rises that how doctors decides that this particular patient has this particular disease with such surety. In order to do that doctors does some investigations so let’s explore these process and what they actually shows and entails

COPD

Diagnosis

So first examinations will start with asking about symptoms, their history like does patient has a habit of smoking or exposure to pollutants

Then he goes for physical examination in which he will listened to your lungs using a stethoscope for abnormal breath sounds.

Investigations

Pulmonary function test:

So basically this test the working of lungs by checking or assessing in medical term your airflow, volume of lung and gaseous exchange.

Abnormalities:

so normally the airflow, lung volume will be decreased.

FEV1/FVC < 70%

Chest X ray:

Chest X ray can show hyperinflatted lungs, flattened diaphragms and lung hyperlucency.

Abnormalities:

If there is COPD, there will be increase marking of lungs, signs of lung damage

Arterial Blood Gas analysis:

This test measure the oxygen level and co2 in your body

Abnormalities:

If there is COPD, this test will show the high Co2 and low O2 which shows the abnormal gaseous exchange.

Myocardial Infarction (MI) or Heart attack

Diagnosis

If somebody is having pain in his chest or have a difficulty in breathing they should seek medical help as soon as possible. When you get the medical help the doctor will examine you where he will check for your vitals, your heart sound and your lung sounds. To confirm the diagnosis the doctor will suggest the following investigations :

Investigations

Electrocardiogram

This test records the bioelectrical activity of heart and this can detect rhythm abnormalities in your heart which in medical term is known as cardiac arrhythmia.

Abnormalities

In ECG, we can see there will be depression or elevation in ST segment, T wave will be inversed, Q wave will be abnormal which can show that there is either myocardial ischemia or infarction.

Cardiac enzyme test

In this test, troponin levels like certain enzymes level will be measured in blood. When heart muscle cells are damaged this enzyme will be there in blood stream.

Abnormalities

If there is any problem with heart troponin level will rise which tells that there is injury or infarction of cardiac muscles.

Echocardiogram

Echocardiogram is sounds like ECG but both are different because echocardiogram or in normal language 2D echo uses sound waves which will create a image of your heart and will tell if there is any structural abnormalities.

Abnormalities

In 2D, wall of heart will have problem while being moving, there will be a muscle damage which can be seen and also there will be reduced heart function

Hemiparesis

Diagnosis

If somebody is experiencing sudden weakness on half or one side of the body, they should get immediate medical attention, when a patient goes to a doctor with a complain of sudden weakness , doctor will do some examination of their strength of the muscles, sensation of the body that if they can feel anything or not , balance and coordination. To confirm the diagnosis the doctor may advice to do following investigations.

Investigations

Brain Imaging studies

With Imaging tests, like CT Scan or MRI of brain, one can check for bleeding, or blood loss or no blood supply of the part of brain.

Abnormalities

In CT scan or MRI, we can see damage brain tissue, blood clots, or some lesions if there is any neurological conditions is there.

Blood tests

In this test, Complete blood count will be there, level of electrolytes and coagulation studies, which helps to identify underlying medical conditions.

Abnormalities

In this test, WBC count will be increased and also clotting abnormalities will be there.

Carotid Doppler Ultrasound

Just like 2D this tests also uses sound waves to check the blood flow in carotid arteries which are present in the neck.

Abnormalities

In this test if there is hemiparesis is present, there will be blockage of the arteries.

Management

Drugs used in MI(Myocardial infarction), COPD and Hemiparesis

So, to treat Mi, COPD and hemiparesis, there are some medication is used which are common. Let’s discuss them along with the reason of their use

Medications for COPD

Bronchodilators:

So broncho means bronchus and dilators means molecules which are there to dilate or to relax. These drugs helps in relaxation of the airway muscles. So the patient can easily breath.

This bronchodilators, will relax the airways smooth muscles which are present in lungs. So in the result will get a airflow improvement and airway dilations

There are two types of bronchodilators:

Short-acting bronchodilators:

This are short acting drugs which provides faster relief during a exacerbations of COPD

Long-acting bronchodilators:

This are long acting drugs but they have to be used daily in need to keep open the airways and decrease the symptoms over time.

Inhaled Corticosteroids:

So these drugs are anti-inflammatory means they decreased the inflammation which is present in airways, because of which lung function is improved and exacerbations are prevented.

Medications for Myocardial Infarction (MI)

Aspirin:

There are some enzymes called cyclooxygenases or COX, they are involved in production of prostaglandins. So this drug prevents this activity. So when this enzyme is stopped, inflammation, fever and pain is decreased, and also aggregation of platelets are stopped so there is no more blood clot formation.

Beta Blockers:

So, there are receptors (one kind of proteins) called beta-adrenergic receptors which are present on heart. So beta blockers blocks the adrenaline and other stress hormone’s effect on these receptors, because of which there will be decrease in heart rate, blood pressure which will result in reduce workload on heart. So when there is decrease in workload there will be less demand of oxygen by cardiac muscle and it will also improve the blood flow.

ACE inhibitors:

ACE stands for angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. So this inhibitors prevents the conversion by blocking this enzyme. This angiotensin II is a vasoconstrictor, so when this process is inhibited, the blood vessels will not get constricted instead they will dilate, so there will be less blood pressure.

Statins:

In our body, there are so many enzymes which are responsible to carry out many processes. One of them is HMG-CoA reductase, this enzyme synthesises the cholesterol in our liver. So these type of drugs inhibits this enzyme, the cholesterol level will be decreased.

(they are also anti-inflammatory drugs and can stabilize plaques in the arteries)

Medications for Hemiparesis

Muscle Relaxants:

So these drugs mainly work by blocking the nerve signals and also on muscle fibers. So the tone of the muscle will be decreased and there will be reduction in spasm.

Pain relievers:

This drugs will work on a chemical called prostaglandins which is responsible for inflammation, pain and fever. This drugs will prevent the production of the chemical which will help in pain and fever.

Blood thinners:

Also known as anticoagulants, will interfere in the process of blood clotting which will result in less blood clot formation.

Physiotherapy management:

Myocardial infarction

Strength training

Circuit programme

Warm up / 15 minutes / Very light >> Light

COPD:

Hemiparesis: