CHAPTER VII

ANATOMY AND PHYSIOLOGY

A Myocardial Infarction, commonly known as Heart Attack, is a deadly

medical emergency where there is a lack of blood flow and oxygen to a region

of the heart, resulting in death of the cardiac muscle cells. Myocardial Infarction

often occurs when a coronary artery is blocked by the buildup of atherosclerotic

plaque consisting of lipids, cholesterol and fatty acids, and white blood cells,

primarily macrophages. It can also occur when a portion of an unstable

atherosclerotic plaque travels through the coronary arterial system and lodges

in one of the smaller vessels.

Figure 2: Anatomy of the heart.

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Narrative

The Heart is a fist-sized organ that pumps blood throughout human

body. Located between the lungs in the middle of the chest, behind and slightly

to the left of the breastbone. Blood is crucial to remain alive because it carries

oxygen and nutrients from the heart to other tissues throughout the body. It also

carries waste products such as carbon dioxide away from the tissues.

On the right side, Oxygen-poor blood from all over the body enters the

right atrium through two large veins. The tricuspid valve opens to let blood travel

from the right atrium to the right ventricle. When the right ventricle is full it

squeezes and opens the pulmonary valve. Then blood flows through the

pulmonary artery to the lungs, where it gets oxygen. On the left side, through

the Pulmonary Veins, the Oxygen-rich blood travels from the lungs to the left

atrium. The mitral valve opens to send blood from the left atrium to left ventricle.

When the left ventricle is full, it opens the aortic valve. Then the blood flows

through aortic valve to aorta and flows to the rest of the body.

The heart walls are the muscles that contract and relax to send blood

throughout the body. The heart walls have three layers: epicardium,

myocardium, and the endocardium.

The Epicardium is one layer of your pericardium, a protective sac that

covers your entire heart. It produces fluid to lubricate your heart and keep it

from rubbing against other organs.

The middle and thickest layer is the myocardium, made largely of

cardiac muscle cells. It is the contraction of the myocardium that pumps blood

through the heart and into the major arteries.

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 The innermost layer of the heart wall, the endocardium, it lines the

chambers where the blood circulates and covers the heart valves.

Figure 3: Anatomy of the Endocrine System.

Pituitary gland is a small gland about the size of a pea that regulates growth,

metabolism, and reproduction through the hormones that it produces.

Hypothalamus is an important autonomic nervous system and

endocrine control center of the brain that keeps your body in a stable state

called homeostasis.

Thyroid Gland helps to regulate many body functions by constantly

releasing a steady amount of thyroid hormones into the bloodstream.

Parathyroid Gland produce parathyroid hormone, which plays a key role in the

regulation of calcium levels in the blood.

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 Adrenal Gland produces hormones that help regulate your metabolism,

immune system, blood pressure, response to stress and other essential

functions.

Pancreas is responsible for the production of hormones that regulate

blood sugar levels and glandular secretion.

Testes aids in the sperm cell production, maintenance of functional

reproductive organs, secondary sex characteristics and sexual behavior.

Ovaries aid in uterine and mammary gland development and function,

external genitalia structure, secondary sex characteristics, sexual behavior and

menstrual cycle.

Thymus promotes immune system development and function.

Pineal Gland Inhibits secretion of gonadotropin-releasing hormone,

thereby inhibiting reproduction.

Figure 4: Anatomy of the Muscular System

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 Skeletal muscle: This type of muscle creates movement in the

body. When the nervous system signals the muscle to contract, groups

of muscles work together to move the skeleton.

Cardiac muscle: This type makes up the walls of the heart and

creates the steady, rhythmic pulsing that pumps blood through the body

from signals from the brain. This muscle type also creates the electrical

impulses that produce the heart’s contractions, but hormones and stimuli

from the nervous system can also affect these impulses, such as when

your heart rate increases when you’re scared.

Smooth muscle: makes up the walls of hollow organs, respiratory

passageways, and blood vessels.

Figure 5: Anatomy of the Respiratory System

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 Nasal Cavity filters and warm the air as it moves through these

passages during breathing., and make it moist before it goes into the lungs.

Pharynx serves both the respiratory and digestive systems by receiving

air from the nasal cavity and air, food, and water from the oral cavity.

Larynx protects the lower respiratory tract from aspirating food into the

trachea while breathing. It also contains the vocal cords and functions as a

voice box for producing sounds

Trachea carry air in and out of your lungs. Because it's a stiff, flexible

tube, it provides a reliable pathway for oxygen to enter your body.

Bronchi distribute the air throughout the lungs until reaching the

respiratory bronchioles and alveolar sacs

Lungs the process of gas exchange called respiration. In respiration,

oxygen from incoming air enters the blood, and carbon dioxide, a waste gas

from the metabolism, leaves the blood. A reduced lung function means that the

ability of lungs to exchange gases is reduced.

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 CHAPTER VIII

ETIOLOGY AND SYMPTOMATOLOGY

This chapter deals with the causation of the disease and symptoms

manifested by the patient having a particular medical condition. Thereafter,

understanding the etiology and symptomatology mechanism of the disease is

relevant in rendering effective interventions (Suh, Cho, & Zhang, 2018).

Acute myocardial infarction is a decreased coronary blood flow caused

by a blockage in one or more of the coronary arteries that take oxygen-rich

blood specifically to the heart muscle. A blockage or narrowing of these arteries

can develop due to a buildup of plaque, a substance mostly made of fat,

cholesterol, and cellular waste products or due to a sudden blood clot that forms

on the blockage. The available oxygen supply cannot meet oxygen demand,

resulting in cardiac ischemia. Atherosclerotic plaques classically rupture and

lead to thrombosis, contributing to acutely decreased blood flow in the coronary

arteries (Mechanic, 2022).

In transmural MI, tissue damage extends through all myocardial layers.

As the normal arterial wall consists of smooth muscle and connective tissue

layer of endothelial cells lining the lumen of the artery. In atherosclerosis,

macrophages ingest cholesterol and other lipids, then form fatty streaks in the

extracellular matrix just under the endothelial lining of the layer arteries. As the

streak grows, it forms a lipid core. Paracrine released by the macrophages

attract smooth muscle cells that migrate from the underlying layer of vascular

smooth muscle. In additional, the migrating smooth muscle cells divide,

thickening the arterial wall and narrowing the lumen of the artery. When the

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endothelium is damaged and collagen is exposed, platelets will stick to the

damaged area and to each other. A blood clot (thrombus) may form on the wall

of the vessel. If blood flow in the coronary blood vessel is stopped that will result

to heart attack.

Figure 6: Anterior wall infarct.

Table 1. Predisposing factors.

Predisposing Present / Rationale Justification
Factors Absent

Sex Present Men have a 3-4 times higher The patient is

risk of developing coronary Male.
artery disease through
middle age than women do
because they have larger
heart and blood vessels

Age Present Men age 45 or older are The patient is 56

more likely to have a heart years old.
attack than are younger men
as serum total cholesterol
increases as age increases

Family History Present There is a higher risk of All of the patient's

of acquiring the disease siblings are
Hypertension through genetics which later diagnosed with
on, the high blood pressure hypertension.
can damage arteries that
leads to the heart

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Table 2. Precipitating factors.
Precipitating Present / Rationale Justification
Factors Absent

Sedentary Present Lack of exercise has The patient is a stay-

lifestyle been linked of 7- at-home retired Cafgu
12% of cases for 7 years with no
noted active physical
activities done.

Cigarette Present Increases a The patient was an

Smoking person’s risk for active heavy cigarette
heart disease to smoker for 30 years.
about 4x greater He can finish more
than non-smokers than 20 cigarette sticks
as cigarette smoking a day.
speeds up the
clogging and
narrowing of
coronary arteries

Diabetes Present High blood sugar The patient has Type 2

damage blood Diabetes Mellitus as
vessels and the noted on his final
nerves that control diagnosis upon his
the heart admission on April 22,
2023

Stress Present Stress such as The patient stressed

emotional stress can over his unhealed left
cause the heart to foot.
work harder,
increase blood
pressure, and
increase sugar and
fat levels in the
blood

High Cholesterol/ Absent A high level of LDL The patient's lab

Triglycerides cholesterol is most results display a
likely to narrow normal range of LDL
arteries. A high level Cholesterol which is
of certain blood fats 1.27 mmol/L.
called triglycerides
increases heart
attack risk. The
normal vakue of
LDL Cholesterol is
<4.94 mmol/L

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 Unhealthy Diet Present A diet high in The patient is noted
sugars, animal fats, with high carbohydrate
processed foods, intake as evidenced by
trans fat and salt his daily intake of Coca
increases the risk of cola of around 750 ml
heart attacks. and he can consume
4-5 cups of rice a day
for 30 years.

Table 3. Symptomatology.
Symptoms Present / Rationale Justification
Manifested by Absent
Patient X

Chest Pain Present Severe, recurrent chest The patient reported

pain not relieved by rest, persistent
position change, or substernal pain
nitrate administration is before going to bed
the Hallmark of an MI before admission.

Syncope Present A brief loss of The patient fainted

consciousness (from a due to difficulty of
few seconds to a few breathing related to
minutes), that is hypersensitivity
characterized by rapid allergic reaction to
onset and spontaneous Sumapen medicine.
recovery.

Cardiovascular Present In response to the The patient's Blood

Manifestation release of Pressure is 100/80
catecholamines, BP and mmHg upon
HR may be elevated admission.
initially. Later, the BP
may drop because of
decreased cardiac
output (CO).

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 CHAPTER IX

PATHOPHYSIOLOGY

PREDISPOSING FACTORS PRECIPITATING FACTORS

⚫ Age (57 Years Old) ⚫ Sedentary Lifestyle

⚫ Gender (Male) ⚫ Excessive Intake of
⚫ Family History of Carbohydrates
hypertension ⚫ Cigarette Smoking
⚫ Type 2 Diabetes Mellitus
⚫ Unhealthy Diet
⚫ Stress

Opening in the endothelium lining

Accumulation of LDL
Cholesterol on Coronary Artery

Chest Pain
Gradual Arterial Obstruction
and Building up of Plaque
Shortness of Breathing

Stable Myocardial Infarction

Ruptured of Plaque (Coronary Aggregation of Platelets

Thrombosis) into Ruptured Plaque

Complete Occlusion of the

Coronary Artery

Unstable Myocardial Infarction

Angina due to Hypoxia

Ischemia of Cardiac Muscle

Initial Infarction into

Cellular Necrosis Myocardium

Acute Transmural Myocardial

Infarction

If Treated If Untreated

Medical Low oxygen in blood and other

Management: Patient will have a normal
body organ in body
blood flow into heart
⚫ Treatment IV
Fluids and
Medications Difficulty in pumping blood
No further abnormalities in vital into other organs
⚫ Reperfusion signs of patient resulting to
Therapy Improved Condition

Permanent necrosis of cardiac

Fair Prognosis muscle

Bad Prognosis
Discharge 24
Death
NARRATIVE

Acute transmural myocardial infarction (MI), also known as ST-segment

elevation myocardial infarction (STEMI), is a type of heart attack that occurs
when there is a complete blockage of a coronary artery, which supplies blood
to the heart muscle. The blockage is usually caused by the formation of a blood
clot on a plaque, a buildup of cholesterol and other substances, in the inner
lining of the artery. The lack of blood flow and oxygen to the affected area of
the heart muscle can lead to damage or death of the tissue also known as
infarction.
The term "transmural" refers to the fact that the damage extends through
the full thickness of the heart muscle, from the inner to the outer layers. This
can result in a more severe and potentially life-threatening form of MI, as
compared to non-ST segment elevation myocardial infarction (NSTEMI), where
there is partial blockage of a coronary artery. Acute transmural myocardial
infarction is a medical emergency and requires immediate treatment to restore
blood flow to the affected area of the heart. Treatment may include medications,
such as aspirin and nitroglycerin, and procedures such as angioplasty or
coronary artery bypass surgery, to open up the blocked artery and restore blood
flow.

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