19 Sep A 47-year-old overweight male with a history of at
A 47-year-old overweight male with a history of atherosclerosis, diabetes mellitus type 2, and coronary artery disease (CAD) is found by a neighbor unconscious and not breathing in his front lawn where he appears to have been mowing his lawn. He is rushed to a local emergency room where it is determined that he has suffered a massive inferior myocardial infarction. He is sent to the intensive care unit in critical condition where he is placed on advanced life support equipment, and several days later it is determined that he has minimal brain activity.In your initial post answer the following question:I would answer her question by briefly describing the pathophysiology of a myocardial infarctionand include probable causes if known. As cardiogenic shock. Afterwards, I would explain the effects of cardiogenic shockor anything that could impair blood flow (i.e. thromboembolism) to the brain. Then, I would apply this to the patient’s current state. The patient has risk factors (age, male, overweight) and a past medical history that includes heart disease and atherosclerosis (Kaur, 2014).. These conditions predisposed him to vascular disease, stroke, and myocardial infarction (Kaur, 2014). I would delicately explain to her these factors (heart disease and atherosclerosis) that likely contributed to his heart attack and how these conditions add to the complexity of his treatment.Her husband’s brain injury is the result of severe hypoxia due to probable cardiogenic shock after his acute myocardial infarction. Decreased oxygen delivery to the brain (anoxia) leads to brain tissue ischemia. According to Grossman and Porth (2013), an interruption in blood flow to the brain longer than four to five minutes will lead to ischemia.This patient was probably without cerebral perfusion for more than five minutes before he was found which worsens his chances for survival. The brain makes up only 2% of the human body weight but it requires 15 to 20% of our resting cardiac output (Grossman & Porth, 2013).Signs of cerebral ischemia can include completeloss of consciousness which is the case for her husband.Brain injury as a result of decrease blood flow occurs in steps. Ischemia is the result of hypoxia in this case and it leads to decreasedglucose delivery and impaired waste removal (Grossman & Porth, 2013).Oxygenated blood is needed for anaerobic metabolism of glucose butthere is decreased oxygen. The cells in the central nervous system are not equipped like muscles cells to store glucose for cellular metabolism or maintain extended anaerobic metabolism. The decrease in oxygen leadto the utilization of theless efficient anaerobic metabolism for the brain cells. The decrease in available glucose forces brain cells to use other substrates like lactate, glutatamate, pyruvate, and glutamine for energy. Switching to anaerobic metabolism in the nervous system as a result of severe anoxia is not sustainable and quickly leads to brain cell injury then irreversible cell death. Neurons are nonmitotic so there is no chance for regeneration of brain cells.Her husband likely had a heart attack which subsequently led to cardiogenic shock. Shock shunts blood to vital organs to compensate for cardiac output. When his heart failed to supply brain cells with adequate oxygenated blood, brain cells were damaged. Although the initial injury occurred in the cardiovascular system, the nervous system is reliant on oxygen rich blood for normal functioning. Any small change to blood oxygen content causes an observable change in neurological status. Mild changes to oxygen content in blood might manifest as altered mental status whereas severe hypoxia (anoxia) such as this case, will result is loss of consciousness.Again, I would give facts about the pathology and statistics, however, this time I would add in facts about brain injury, prognosis, and measures that will need to be taken to keep him alive. Depending on the extent of the brain injury, he may require mechanical ventilation and long-term care. Quality of life, family support and what the patient’s wishes were are important topics to be discussed. I would refrain from offering my personal opinion. I would explain to the patient’s wife and family that the severity of his illness has to do with his neurological status. Brain injury that leads to brain cell death is permanent. Though he has been resuscitated his chances of survival are small especially since it is unknown for how long he was down.ReferencesGrossman, S. & Porth, C.M. (2013). Porth’s pathophysiology: Concepts of altered health states (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &Wilkins.Kaur, J. (2014). A comprehensive review on metabolic syndrome. Cardiology research and practice,
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