Module 3 Discussion, Case Study 1: Alterations of Cardiovascular Function
Case Study Questions
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Several risk factors predisposed the patient to acute myocardial infarction. Two of these are age and gender. Anderson and Morrow (2017) indicate that the lifetime risk of developing this condition is 50% for 45-year-old men in cases where there are 2 or more other major risk factors. Given that Mr. G is 53 years and male, he is vulnerable to AMI. Another risk factor is physical activity since the patient was playing tennis with a friend. A study carried out by Smyth et al. (2016) found out that 13.6% of AMI cases followed physical exertion. Also, acute myocardial infarction onset in summer is closely associated with maximum temperatures two days before the onset (Akioka et al., 2019). Hence, hot temperature also served as a risk factor.
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Four clinical signs indicate that acute myocardial infarction has occurred in the left ventricle and not the right ventricle. One of these signs is chest discomfort. This is associated with acute myocardial infarction in the left ventricle as fluid moves back into the lungs due to the inefficiency of the ventricle to pump blood to the arteries. The other sign is a crushing sensation in the sternal area. It is also associated with left ventricle infarction. Thirdly, the pain that spread towards his neck and lower jaw is as a result of nerve irritations caused by swelling in the lung area caused by infarction in the left ventricle. Finally, deep breathing indicates that the patient may have experienced shortness of breath associated with the occurrence in the left ventricle (Anderson and Morrow, 2017). Signs for Right Ventricular Infarction mostly include swelling in the legs and abdomen as the veins are unable to take blood into the heart.
The best-recommended laboratory test for acute myocardial infarction uses cardiac biomarkers. These are substances that are released into the blood once the heart is either stressed or damaged. Biomarkers such as natriuretic peptides have been in use for a long time. However, their use has declined to pave way for next-generation biomarkers (Chow et al., 2017). Currently, the recommended biomarker is Troponin T. It is a protein released into the blood when the heart muscle is damaged by a heart attack (American Heart Association News, 2018). Troponin T has been found to provide a faster and clearer analysis for acute myocardial infarction.
Various pathophysiological mechanisms led to elevated temperature after the onset of acute myocardial infarction. One such mechanism is the inflammatory reaction following myocardial necrosis. In this case, elevated body temperature serves as an indication of the death of heart cells (Qian, Liu, Ma, Meng, & Peng, 2014). Another mechanism is the elevated serum levels of cardiac enzymes derived from the myocardium. Following myocardial infarction, cardiac enzymes are released into the blood. These include cardiac biomarkers such as troponin, myoglobin, and creatine kinase. The elevated levels of the serum of these enzymes can raise body temperature. Additionally, the increased activation of the Immune system can lead to fever. This activation is aimed at promoting the remodeling of the left ventricle (Qian et al., 2014). A study has shown that there are immune cells in nearby pericardial adipose tissue that trigger the inflammation effect (Matloch, ZCinkajzlova, Mraz, & Haluzik, 2018). These pathophysiological mechanisms may lead to elevated temperatures.
Akioka, H., Yufu, K., Teshima, Y., Kawano, K., Ishii, Y., Abe, I., … & Nagano, Y. (2019). Seasonal Variations of Weather Conditions on Acute Myocardial Infarction Onset: Oita AMI Registry. Heart and Vessels, 34(1), 9-18.
American Heart Association News. (6 Aug. 2018). New Blood Test is Better, Faster at Diagnosing a Heart Attack. American Heart Association. Retrieved from https://www.heart.org/en/news/2018/08/06/new-blood-test-is-better-faster-at-diagnosing-a-heart-attack
Anderson, J. L., & Morrow, D. A. (2017). Acute Myocardial Infarction. New England Journal of Medicine, 376(21), 2053-2064.
Chow, S. L., Maisel, A. S., Anand, I., Bozkurt, B., De Boer, R. A., Felker, G. M., … & Liu, P. P. (2017). Role of Biomarkers for The Prevention, Assessment, And Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation, 135(22), e1054-e1091.
Matloch, Z., Cinkajzlova, A., Mraz, M., & Haluzik, M. (2018). The Role of Inflammation in Epicardial Adipose Tissue in Heart Diseases. Current Pharmaceutical Design, 24(3), 297-309.
Smyth, A., O’Donnell, M., Lamelas, P., Teo, K., Rangarajan, S., & Yusuf, S. (2016). Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction: The Interheart Study. Circulation, 134(15), 1059-1067.
Qian, Y., Liu, J., Ma, J., Meng, Q., & Peng, C. (2014). Effect of Initial Temperature Changes on Myocardial Enzyme Levels And Cardiac Function In Acute Myocardial Infarction. Experimental and Therapeutic Medicine, 8(1), 243-247.
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