LindsayVasquez

Week9
1.

Howdoescellularhypoxialeadtoimpairmentofcellularfunction?
Oxygenisarequirementforallcellsofthebodytofunctionproperly.Whenischemia,ordecreasedblood
flow,occursoxygendeliveryalsodecreases;ifnotstopsalltogether.Oxygenisessentialtomakethefood
forthecell(ATP)throughaverycomplexprocessofchemicalreactions(oxidativephosphorylation).
Withoutoxygenavailabletomakethisfood,thecellisforcedtouseupitstoredenergy(glycogen)ina
processknownasanaerobicmetabolism.Inthisprocessthereisabuildupofmultiplechemicalsthatreek
havoconthecellsstability.Forexample,thecellscapsulestartstobecomeweakenedandfluidstartto
accumulatewithinit,causingthecelltoswell.Also,thebyproductofglycogenbreakdown(lacticacid)can
impaircellularfunctionandcanleadtocelldeath(apoptosis).

1.

Whatthreemechanismareabnormalinthesystolicformofleftheartfailure(commonlycalled
congestiveheartfailure),andhowaretheymanaged?
Thethreemechanismsthatareaffectedincongestiveheartfailurearecalledcontractility,preload,and
afterload.Contractilityistheforceinwhichtheheartsqueezesthebloodthroughitschambersandoutinto
peripheralcirculation.Thecellsoftheheartcanbecomeweakenedanddisplaythischaracteristicwhen
ischemiaoccurs,thatofwhichIexplainedinthepreviousquestion.Thisischemiacancausesudden
immediatedamageviaaclotorslowprogressivedamagefrompartialocclusions.Thereisaclassof
medicationscalledinotropesthatspecificallyworkonheartmuscletoincreasethiscontractility,for
exampleDopamine,Digoxin,andDobutamine.Withthesedrugs,theheartisabletopumpmore
efficiently.Preloadistheamountofbloodorfluidvolumeavailabletothehearttofillitupbeforeit
pumps.Preloadiswhatfillstheventricles,orlowerchambersoftheheart,andstretchesthemoutright
beforetheheartejectstheblood.Thiscanbeaffectedbythetotalvolumeofbloodorfluid(plasma)
circulatinginthebody.Saltrestriction,diuretics,andweightmonitoringareeffectivewaystomanage
preloadintheCHFpatient.Finally,afterloadistheforceinwhichtheheartshastoworkagainsttoeject
bloodoutoftheheart.Forexample,inhypertensivepatientstheheartistryingtopushallthebloodoutinto
astrawandworkingextremelyhardtodoso,whereasinnormalpatientstheheartispushingbloodoutinto
agardenhose.Thiscanbetreatedwithantihypertensives.Onecompoundingeffectisifpreloadisleft
unchecked,itcaninverselydecreasecontractilitybyfurtherweakeningtheheartmuscleandstretchingit
toofar.Similarlyafterloadcanweakentheheartmusclebyprolongedrequirementsofincreased
contraction.

1.

Whatistherelationshipbetweenmyocardialischemia,angina,anddiabetesmellitus?
Myocardialischemiaisalackofbloodflowtohearttissue,whichcanleadtoanginapectoris,orchestpain.
Thehearttissueisnotreceivingenoughbloodflowandnutrients.Thepainiscausedbythebuildupof
chemicalsproducedfromcelldeathandthestretchingoftheheartmusclefibersfromweakness.Diabetes
cancausealackofsensationinthechestpainandcancauseapatienttomissthesymptomsofaheart
attack.Alsoprolongeddiabetescanleadtoissuessuchasthickeningofbloodvesselwallsandanincrease
inclotformationwhichcanfurtherprecipitateischemia.
LindsayVasquez
Reference:

Heuther,S.E.&McCance,K.L.(2012).UnderstandingPathophysiology.St.Louis,Missouri:Elsevier
Mosby.