Overweight and obesity are world-wide health-related problems that affect a significant part of the population. It is known that overweight is closely related to the development of various heart and vascular diseases, in particular, hypertension. Middle-aged and elderly people are especially in danger due to the decrease of vessel walls elasticity, which leads to high blood pressure. Increase of the body mass leads to a higher load on the heart and difficulties in its functioning. In addition, sedimentary lifestyle enhances the probability of heart and vascular diseases emergence. At the same time, overweight influences cardiomyocytes indirectly by affecting metabolic processes, in particular, cellular respiration and availability of nutrients in plasma (Borlaug & Reddy, 2016). All these conditions are related to each other and their effects are summarized. Therefore, it has been proved that overweight has adverse effects on the cardiovascular system and leads to various metabolic problems and diseases, including hypertension, tissue ischemia, and enlarged heart. These conditions are highly dangerous. Without appropriate treatment, symptoms of a patient will be getting worse with time. The development of the disease can lead to serious consequences such as heart attack, stroke, and tissue necrosis and result in the patient’s death. In Maria’s case, an elderly overweight woman with the sedentary lifestyle and hypertension has a high probability of the development of cardiovascular diseases, in particular, enlarged heart and tissue ischemia, which were identified during the medical examination.
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Reasons for Tissue Ischemia Development in Maria’s Case. How Might these Reasons Lead to Hypoxia?
According to the Vascular Disease Foundation [VDF] (2012), ischemia is a pathological condition when blood flow is inadequate and does not provide sufficient oxygenation and nutrition of a particular part of the body. Ischemia is related to heart and vascular problems. This condition can affect any part of the body, including heart, brain, intestines, and muscles. Inadequate blood flow leads to hypoxia of tissue cells and to the damage of the tissue, including cells death and tissue necrosis.
Risk factors of ischemia development are obesity or overweight, high blood pressure, elderly age, sedentary lifestyle, diabetes, atherosclerosis, a high level of cholesterol, and smoking (VDF, 2012). In Maria’s case, the woman has such risk factors as senior age, sedentary lifestyle, hypertension, and overweight. Thus, it is possible to suppose that ischemia has developed in this case. Maria also has the following symptoms of ischemia: cold skin of the limbs and tiredness (VDF, 2012). Moreover, limb edema, which was identified in Maria’s case, is also closely associated with myocardial ischemia (Mikami, Kumar, Abdel-Aty, & Friedrich, 2014).
Therefore, two reasons why Maria might have tissue ischemia are the following: she has symptoms of the disease, which are cold limb skin, limb edema, and tiredness, and she is in a high risk group of the disease development due to her age, lifestyle, and overweight. Tissue ischemia results in the inadequate blood flow and affects nutrition and oxygenation of the damaged part of the body. As a result, the state of hypoxia appears. If a damaged organ is the heart, this condition might lead to the heart attack. Thus, it was important to check how Maria’s heart worked. Based on the results of the echocardiogram, it was determined that Maria’s heart was enlarged.
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Early and Reversible Changes of Tissue Cells Hypoxic Conditions?
The work of the heart relies on the ATP energy produced by mitochondria in cells. The process of ATP synthesis heavily depends on the level of oxygen. Thus, in case of tissue ischemia and hypoxia the activity of mitochondria decreases. It means that body cells, in particular, cardiomyocytes cannot perform their functions to the full extent. Due to the decrease in the ATP level, pathological changes in the cells membranes occur. As a result of changes in the membranes electrical charge, Ca2+ ions enter the cells through specific Ca2+ channels. It leads to the ionic misbalance between concentrations of Ca2+ ions within the cells and in the intercellular space. Subsequently, water molecules enter the cells and they start swelling. This process is reversible. However, with time it might lead to the damage of the membranes and the death of cells (Wengrowski, Kuzmiak-Glancy, Jaimes, & Kay, 2014). Thus, two reversible changes of hypoxia in tissue cells are a decrease in the mitochondria activity and ATP production, as well as cells swelling. However, within a short time the death of cells and tissue necrosis might happen, which are irreversible changes.
Cellular Adaptation of Enlarged Heart in the Case of Maria? Reasons for the Conclusion?
The pathological decrease in the level of oxygen in plasma is detected by special chemoreceptors in the human brain. This condition leads to activation of the sympathetic nervous system, intensification of the heart beating, and increase in the blood pressure. The main purpose of this activity is to overcome the hypoxia condition in blood plasma and, correspondingly, in tissues. Thus, the heart must pump blood at a higher rate and cause an increase of the blood pressure. As a result, hypertrophy of cardiomyocytes occurs, which leads to the enlarged heart. Enlargement of heart cells was the cellular adaptation of Maria’s heart to the hypoxia condition, which results in the increase of the organ’s size (de Silva, 2013).
According to de Silva (2013), enlarged heart is associated with such condition as high blood pressure, which was detected in Maria’s case. Thus, based on the case data it is possible to suppose that the sedentary lifestyle and overweight lead to tissue ischemia in Maria’s case. To overcome this condition, high blood pressure and enhanced heart work are required, which has led to the hypertrophy of cardiomyocytes and enlarged heart. This conclusion was based on the combination of Maria’s medical history, symptoms, and results of her examination, in particular, echocardiogram.
Reasons for the Maria’s Heart Enlargement. The Comparison of Maria’s Heart Work and the Well-Trained Athletes’ Heart Strength and Endurance
As it has been stated above, Maria’s heart has become enlarged because it had to overcome the hypoxia condition caused by ischemia. To provide a sufficient amount of nutrition and oxygen to all tissues of the body, the heart rate and force increased. When well-trained athletes perform their physical exercises, their muscles require a significant amount of ATP molecules. For producing ATP, cell mitochondria require oxygen. Thus, well-trained athletes’ heart is physiologically enlarged because their body requires more oxygen, to bring which higher rate and force of the heart are needed (Maron & Maron, 2016). In Maria’s case, the woman’s body also needs more oxygen. To reach this goal, her heart has become larger. It provides her heart with the same strength and endurance as the athletes’ heart. However, this condition is pathological. It has appeared due to the sedentary lifestyle, overweight, and tissue ischemia. Thus, in both Maria’s and athletes’ cases the enlarged heart is the response to an increased need in oxygen.
To conclude, Maria is an overweight woman who leads the sedentary lifestyle. It has resulted in the tissue ischemia and the lack of oxygen, as well as inadequate nutrition. In response to this condition, her heart has to pump blood faster and become stronger. Two consequences of this action have emerged: the constantly high blood pressure and the hypertrophy of cardiomyocytes, which has led to the enlarged heart. Maria claims that such symptoms as cold limb skin, legs edema, and tiredness have appeared. Based on the symptoms, tissue ischemia and enlarged heart were supposed to be the reasons for the woman’s condition. Medical examination, in particular, echocardiogram, has proved this supposition. The woman’s disease is rather serious. Maria requires the appropriate treatment to overcome tissue ischemia and normalize her tension and the heart state. Without the appropriate treatment, heart attack is the most possible consequence of the disorder.