Case Background
A 55-year-old high school teacher with a history of asthma developed a worsening cough and chest tightness. Despite using his inhaler, his symptoms escalated to chest pain, sweating, light-headedness, and difficulty breathing. While driving home, he lost consciousness and crashed into a curb. On arrival, paramedics found him unconscious with ST segment elevation in EKG leads V3 and V4, shallow pulse, and 10 breaths/min. At the ER, his troponin level was 13 ng/L and CK level was 265 U/L.
Cardiovascular and Cardiopulmonary Pathophysiologic Processes Resulting in Patient Symptoms
The description of the patient’s symptoms, including shortness of breath, chest pain, sweating, and light-headedness, suggest the diagnosis of an ischemic myocardial infarction (MI). The pathophysiology of MI depends on the cause, but the most common starting factor is the presence of plaque buildup in the coronary artery (McCance & Huether, 2019). It is likely that the plaque ruptured and blocked the blood flow in an artery, which resulted in the limited supply of oxygenated blood to a part of the heart muscle. As a result, the lack of oxygen supplied to the heart muscle cells – cardiomyocytes – led to the depression of the heart’s function (McCance & Huether, 2019).
As cardiomyocytes stopped getting oxygen, they sent signals to the brain, causing the first potential symptom – pain in such regions as the chest, abdomen, left or right arm, and neck (McCance & Huether, 2019). The death of cells causes a subsequent increase in heart rate, as the heart muscle has to compensate for necrotized tissue, which is caused by an influx of adrenaline in the blood (McCance & Huether, 2019). Such signs as sweating and increased pulse are indicative of this process.
Furthermore, MI also involves the cardiopulmonary system, as the blockage is linked to insufficient oxygen supply to the heart muscle. As the blood passes the lungs for oxygenation, a plaque may cause the buildup in the lungs, leading to shortness of breath – a major symptom in the case of the patient. This process explains why the patient experienced chest tightness that did not resemble asthma and why his rescue inhaler did not relieve the pain (McCance & Huether, 2019).
Finally, the symptom of dizziness is connected to the fact that the brain, similar to other organs, has limited access to oxygen, which affects its processes (McCance & Huether, 2019). The tests performed during hospitalization also confirm the diagnosis of MI. Cardiomyocyte death releases troponins in the blood, which is evident from the patient’s high troponin levels in blood tests (McCance & Huether, 2019). At the same time, high levels of creatine kinase confirm heart tissue damage.
Racial and Ethnic Variables Impacting Physiological Functioning
While people of different races and ethnicities may not have significant genetic differences that greatly increase the risk of MI, the risk of socioeconomic disparities may pose a threat to their health. Some potential genetic predispositions exist for African Americans, who often have hypertension (Chi et al., 2020). As hypertension affects heart muscle deterioration and the pressure in arteries, MIs may be more common among black people than white people (Chi et al., 2020).
However, in the United States, black adults may also be at an increased risk of MI due to higher rates of diabetes, heart disease, or other cardiovascular factors (Simon & Ho, 2020). Another potential exacerbating factor is asthma – a chronic respiratory condition that exposes one’s cardiopulmonary system to vasospasms and arteriosclerosis (Picado et al., 2019). Asthma may be more common among populations exposed to worse living conditions, showing a connection between social disparities and health.
Interaction of Pathophysiologic Processes and Their Effects on the Patient
The interaction of health disparities, the patient’s predisposition, and other conditions affect his well-being. For example, as the patient has asthma, he is at a higher risk of MI and is more exposed to significant damage to the heart muscle (Picado et al., 2019). Moreover, such genetic factors as hypertension that develops early in life in many black people result in deterioration of the heart muscle and increased risk of death due to MI, as more cardiomyocytes are lost (Simon & Ho, 2020).
Finally, comorbidities due to socioeconomic disparities can affect non-white patients’ overall health, increasing the chance of MI (Simon & Ho, 2020). For instance, if the patient has diabetes or high cholesterol, there exists a higher possibility of the existence and rupture of plaques in the artery.
References
Chi, G. C., Kanter, M. H., Li, B. H., Qian, L., Reading, S. R., Harrison, T. N., Jacobsen, S., Scott, R., Cavendish, J., Lawrence, J., Tartof, S., & Reynolds, K. (2020). Trends in acute myocardial infarction by race and ethnicity. Journal of the American Heart Association, 9(5), e013542. Web.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier.
Picado, C., Pernigotti, A., & Arismendi, E. (2019). Asthma: A new cardiovascular risk factor. Archivos de Bronconeumologia, 55, 353-354. Web.
Simon, S., & Ho, P. M. (2020). Ethnic and racial disparities in acute myocardial infarction. Current Cardiology Reports, 22, 1-9. Web.