Coronary Heart Disease Essay Paper
Mr. Smith, a 60-year-old man with coronary heart disease, experienced frequent bouts of angina pectoris. One day while moving a piece of heavy furniture, he experienced excruciating pain over his left chest.
He began sweating heavily, became short of breath, and then collapsed. He was transferred to the emergency room at a nearby hospital. Mr. Smith’s EKG was diagnostic of myocardial infarction. Coronary angiography was performed and occlusion was found in an in the descending branch of the left coronary artery. Intravenous drugs were administered to dissolve the clot that was causing the obstruction. His cardiologist informed him that some of his heart muscle had died as a result of the myocardial infarction.
Coronary Heart Disease Essay Paper Discussion Questions:
- Discuss the risk factors for myocardial infarction.
- As per your analysis, what type of cell injury did Mr. Smith sustain and why?
- Differentiate between reversible and non-reversible cell injury.
- Discuss the pathophysiological changes that occur during a myocardial infarction.
- Correlate the subjective and objective findings of myocardial infarction with the disease
DQ -1 Atherosclerosis is a narrowing of the coronary arteries, which can be identified as the leading cause of coronary artery disease. Narrowing of the coronary arteries can lead to a restriction or interruption of oxygenated blood flow to the heart. This narrowing and reduced or interrupted the flow of oxygenated blood can result in stable or unstable angina and possibly myocardial infarction (MI). McCance and Huether (2014, p. 171) suggest, many risk factors for heart disease have been identified, including obesity, cigarette smoking, hypertension, elevated cholesterol, and positive family history (usually defined as having one affected first-degree relative), these are considered objective findings of myocardial infarction. McCance & Huether (2014, p. 1160) reports, subjective signs and symptoms an individual may experience with a myocardial infarction include shortness of breath, sudden excruciating chest pain with radiation to the neck, jaw, back, shoulder, or left arm is common. Nausea and vomiting may occur and some individuals may report no symptoms, thereby having a “silent” infarction.
From my analysis of the case study and the supporting information from this week’s readings, it appears that Mr. Smith sustained an irreversible cell injury. McCance & Huether (2014, p. 1158) reports cardiac cells can withstand ischemic conditions for about 20 minutes before cellular death occurs. The case study mentions findings of an occlusion in the descending branch of the left coronary artery (LCA) and the Cardiologist reports to Mr. Smith that part of the heart muscle “died”. According to McCance & Huether (2014, p. 54-55), injured cells may recover (reversible injury) or die (irreversible injury). Peate & Jones (2014) suggests, the most common cause of an MI is a blood clot (thrombosis) forming inside a coronary artery, or one of its branches. This prevents blood flow to a part of the heart. A coronary artery or one of its smaller branches becomes blocked suddenly, resulting in damage to the myocardium. According to Peate & Jones (2014), where the infarct has taken place, a collagen scar forms in its place and the damaged muscle fails to contract efficiently. Collagen, a bundle of non-contactable, non-stretchable fibers. The inelasticity of the collagen is what causes the ineffective contraction and stretch of the myocardium, a decrease in cardiac output is the result.
Coronary Heart Disease Essay Paper References
McCance, K.L. & Huether, S.E. (2014). Pathophysiology: The biological basis for disease in adults and children. St. Louis, MI: Elsevier.
Peate, I & Jones, N. (2014). Pathophysiology series 2: Acute myocardial infarction. British Journal of Healthcare Assistants, 8(5): 214-219. 6p. (Journal Article – glossary, pictorial, tables/charts) ISSN: 1753-1586, Database: CINAHL Plus with Full Text
DQ- 2 Myocardial infarction (MI) results when prolonged ischemia causes irreversible damage to the heart muscle and sudden cardiac death can occur because of any of the acute coronary syndromes (McCance &Huether,2014). Myocardial infarction (MI) is the most severe form of coronary heart disease and the major cause of mortality in the world. There are several risk factors leads to MI such as obesity, cigarette smoking, hypertension, elevated cholesterol level, and positive family history. Also, age and sex are other nonmodifiable risk factors for MI. According to McCance and Huether (2014), there are several studies proved that that an individual with a positive family history is two to seven times more likely to coronary artery heart disease that is an individual with no family history. According to the INTERHEART study, risk factors for MI can be divided into 2 categories and which includes ,emerging risk factors (homocysteine, glucose abnormalities, nutritional factors, abdominal obesity and psychosocial factors) and conventional risk factors (hypertension, diabetes, smoking and elevated cholesterol) between people of varying geographic and ethnic origin (Huma, Tariq, Amin & Mahmood, 2012).
In the case of Mr. Smith occlusion was found in an in the descending branch of the left coronary artery and some of his heart muscle had died. Hypoxia, or lack of enough oxygen, is the ultimate reason for the cellular injury. Progressive hypoxia caused by gradual arterial obstruction is better tolerated than the sudden acute anoxia (total lack of oxygen) caused by a sudden obstruction, such as can occur with an embolus ((McCance &Huether,2014). There is sudden acute anoxia happened in the case of Smith due to the clot on the artery and there is some irreversible damage already happened to the cells due to hypoxic injury. According to McCance and Huether (2014), continued ischemia causes irreversible injury, and which is associated structurally with severe swelling of the mitochondria, severe damage to plasma membranes, and swelling of lysosomes.
There are several factors can cause cellular injury and which disrupts cellular structures or deprives the cell of oxygen and nutrients required for survival. This injury can be reversible or irreversible depends on the severity of damage or length of the deprivation of oxygen. The reversible damage is sublethal, but the irreversible injury is lethal. In reversible cell injury, structurally no return and which happen when severe vacuolization of mitochondria occurs and Ca++ moves into the cell, including mitochondrial membrane damage. Whereas in reversible cell injury there is a loss of adenosine triphosphate (ATP), swelling of cell, detachment of ribosomes and autophagy of lysosomes occurs (McCance &Huether,2014).
Usually, coronary arteries supply blood to myocardial cells and if there is any deprivation of the blood supplies to the myocardium will lead to decrease in oxygen supply to the myocardium. There are several reasons present behind the Imbalances between myocardial demand and coronary blood supply. It may be due to atherosclerosis, plaques ulceration or rupture. When this ulceration or rupture occurs, underlying tissues of the vessel wall are exposed, resulting in platelet adhesion and thrombus formation (McCance &Huether,2014). Even 10 seconds of coronary occlusion can lead to ischemia and if the occlusion exists more than 20 seconds it will ends in MI. during this condition, anaerobic processes will happen, and lactic acid will accumulate.
Patients with MI usually have the symptoms of chest pain, radiating to jaw or shoulder, short of breath, nausea, vomiting, profuse sweating, indigestion or pressure in the chest. Final diagnosis of MI can be made from a combination of chest pain characteristics, evolutionary changes on the electrocardiogram and serial analysis of cardiac enzyme levels (Huggon, Chambers, Nayeem, Tutt, Crook & Swaminathan,2001).
Coronary Heart Disease Essay Paper Reference
Huggon, A. M., Chambers, J., Nayeem, N., Tutt, P., Crook, M., & Swaminathan, S. (2001). Biochemical markers in the management of suspected acute myocardial infarction in the emergency department. Emergency Medicine Journal: EMJ, 18(1), 15. doi:http://dx.doi.org/10.1136/emj.18.1.15
Huma, S., Tariq, R., Amin, F., & Mahmood, K. T. (2012). Modifiable and non-modifiable predisposing risk factors of myocardial infarction -A review. Journal of Pharmaceutical Sciences and Research, 4(1), 1649-1653. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1009276246?accountid=87314
McCance, K.L. & Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in adults and children. (7th ed).St. Louis, MI : Elsevier
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