SUO Myocardial Infarction & Hypoperfusion Rebecca Barrett and Christina Soldinger Case Study

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Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates. Participate in the discussion by analyzing each response for completeness and accuracy and by suggesting specific additions or clarifications for improving the discussion question response. Complete your participation for this assignment by the end of the week.

QUESTION #1

Rebecca Barrett

Cardiovascular Case Study

In this case study, Mark, a 48-year-old male is presents to his doctor’s office with mild to moderate chest pressure which radiates to his back. Mark rates his pain 6/10 and reported that he felt like he could belch. Upon arrival to his doctor’s office the receptionist is instructed to call 911. He has a past medical history of Diabetes mellitus 2. Family history consists of premature coronary artery disease and noted that his father died of acute myocardial infarction (AMI) at age 45 and one brother died of an AMI at age 49. He is anxious and shows Levines sign. ECG shows ST segment depression and T wave inversion. Heart tones are muffled with an S3 gallop. Hands and feet are cool to touch. Neck vein distention of 5cm with HOB at 90 degrees. Within 2 hours of arrival for care at the emergency department troponin was 6ng/dl.

Mark exhibited classic symptoms of heart failure including ST segment depression and T wave inversion, muffled heart tones with an S3 gallon, neck vein distention of 5cm and an elevated troponin of 6ng/dl. Cell death occurs in heart failure. “Apoptosis is the most common form of programmed cell death and can be triggered by physical, chemical, and biological factors.” (Proteintech, 2019). Apoptosis helps the body eliminate old unnecessary or unhealthy cells and is essential for normal development. Necrosis is a form of cell injury that is defined by unregulated cell death resulting from internal or external stressors such as mechanistic injuries, chemical agents, or pathogens.” (Proteintech, 2019). The process of necrosis is usually rapid and leads to oncosis. Necrosis operates alongside apoptosis and in conjunction with it (Einstein College of Medicine, 2020).

Both hydrostatic and oncotic pressure are important with regulating the function of the heart. Hydrostatic pressure aids the supply of nutrients to the tissues of the body and oncotic pressure helps to remove metabolic wastes from the tissues. If the pressures are not regulated correctly cell death could occur. The role of free radicals and myocardial death can be quite complicated. Free radicals are deficient in energy and take energy from other cells to satisfy themselves. Experimental studies have shown that free radical scavengers and enzymes that scavenge or degrade reactive species of oxygen can reduce the mass of myocardial tissue that undergoes irreversible injury. (Villines, 2017)

Einstein, 2020, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, https://www.einstein.yu.edu/centers/cardiovascular-research/research/#:~:text=Typically%20in%20heart%20failure%2C%20heart%20cells%20continue%20dying,fluid%20to%20leak%20into%20the%20legs%20and%20ankles.

Proteintech, 2019, What is the Difference Between Necrosis and Apoptosis, https://www.ptglab.com/news/blog/what-is-the-diffe…

Villines, Zawn, 2017, How do free radicals affect the body?, Medical News Today, https://www.medicalnewstoday.com/articles/318652

QUESTION #2

Christina Soldinger posted Sep 24, 2020 8:36 PM
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Describe the similarities and differences of necrosis and apoptosis in regard to the above clinical scenario and diagnosis.
Necrosis and apoptosis are similar because they are both a form of cellular death. Necrosis is the premature death of cells and tissues where apoptosis is a programmed cell death. Apoptosis is a normal healthy process caused by the body and necrosis is caused by external factors including infection or trauma. These are related to the clinical scenario above because necrosis and apoptosis occur in “cardiac myocytes, and both gradual and acute cell death are hallmarks of cardiac pathology, including heart failure, myocardial infarction, and ischemia/reperfusion” (Chiong et al., 2011).
What is the role of hydrostatic and oncotic pressure in regulation of blood pressure for this patient?
Hydrostatic pressure increases filtration and increases filtration by pushing fluids out of the capillaries where oncotic pressure pulls fluid into the capillaries. The hydrostatic pressure is the blood pressure. With a reduction of oncotic pressure there will be an increase in filtration which will result in fluid buildup also known as edema. Edema can cause the blood pressure in a patient to increase.
Explain the role of free radicals and myocardial death.
Free radicals are single atoms that search the body to find other single electrons to pair with. This causes damage the different cells, DNA, and proteins. The free radicals are not good for the body they can cause damage to growth and development to cells in the body. “Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process. Free radicals lead to protein dysfunction, DNA damage, and lipid peroxidation, resulting in cell death” (Sun et al., 2018).
Reference:
Chiong, M., Wang, Z., Pedrozo, Z., Cao, D., Troncoso, R., Ibacache, M., . . . Lavandero, S. (2011, December 22). Cardiomyocyte death: Mechanisms and translational implications. Retrieved September 24, 2020, from https://www.nature.com/articles/cddis2011130
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. St. Louis, MO: Elsevier.
Sun, M., Jin, H., Sun, X., Huang, S., Zhang, F., Guo, Z., & Yang, Y. (2018, January 31). Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy. Retrieved September 25, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58926…