Discussion #1 There are many different risk factors associated with myocardial infarction (MI) or heart attack. Risk factors that are uncontrollable are age, gender and heredity (American Heart Association, 2018). Risk factors that are modifiable are smoking, high cholesterol, blood pressure, obesity and sedentary lifestyle (American Heart Association, 2018). Other risk factors are diabetes, alcohol and stress (American Heart Association, 2018). Although many of these risk factors are preventable, approximately 370,000 people in the US experience an MI annually (Samoraphop, Zahrli, & Hisako, 2018).        Mr. Smith’s injury was a result of hypoxia. Hypoxia develops when there is a lack of oxygen (McCance & Heuther, 2014). A common type of hypoxia is ischemia, which is usually caused by a narrowing or blockage of arteries (McCance & Heuther, 2014). The effects of myocardial ischemia become irreversible and causes necrosis after about twenty minutes (McCance & Heuther, 2014). The most common type of myocardial ischemia is caused by arteriosclerosis which is a gradual narrowing of the arteries induced by plaque build-up (McCance & Heuther, 2014). Mr. Smith’s angiography and requirement of the usage of IV clot dissolvent supports this analysis.         Reversible cell injury is capable when oxygen is supplied back to the cell within a certain amount of time. Irreversible is when the cell has structural changes, mainly damage to the nucleus and has become necrotic (McCance & Heuther, 2014). Rather a cell’s injury is reversible or irreversible depends on factors such as length of time the damage has taken place and the type of damage. Cells can also adapt to damage and still remain functioning (McCance & Heuther, 2014).         The pathophysiological changes that occur to the heart during an MI can be detrimental, it is important to ensure quick diagnostic confirmation of an acute MI to prevent further complication and death. Within 1 minute the heart becomes pale and is not able to contract as efficiently (McCance & Heuther, 2014). In 3-5 minutes. the section of the affected heart stops contracting this causes mitochondria oxygenation to decrease which decreases the production of ATP (McCance & Heuther, 2014). Cellular swelling begins along with the loss of integrity to the plasma membrane (McCance & Heuther, 2014). With the integrity of the plasma membrane compromised the sodium-potassium pump and the sodium-calcium exchanges fail resulting in cellular death if oxygen supplies are not returned (McCance & Heuther, 2014).         Subjective findings for MI are patient complaints of shortness of breath. Chest pain can be described as having severe pain or as though a lot of pressure is “sitting” on the chest (McCance & Heuther, 2014). Some patients complain of nausea and vomiting along with pain described as “shooting” in jaw or left arm (McCance & Heuther, 2014). Objective data for diagnosis of an MI are EKG findings and cardiac enzyme results (Mc.

1. Discussion #1
There are many different risk factors associated with
myocardial infarction (MI) or heart attack. Risk factors that are
uncontrollable are age, gender and heredity (American Heart
Association, 2018). Risk factors that are modifiable are
smoking, high cholesterol, blood pressure, obesity and
sedentary lifestyle (American Heart Association, 2018). Other
risk factors are diabetes, alcohol and stress (American Heart
Association, 2018). Although many of these risk factors are
preventable, approximately 370,000 people in the US
experience an MI annually (Samoraphop, Zahrli, & Hisako,
2018).
Mr. Smith’s injury was a result of hypoxia. Hypoxia
develops when there is a lack of oxygen (McCance & Heuther,
2014). A common type of hypoxia is ischemia, which is usually
caused by a narrowing or blockage of arteries (McCance &
Heuther, 2014). The effects of myocardial ischemia become
irreversible and causes necrosis after about twenty minutes
(McCance & Heuther, 2014). The most common type of
myocardial ischemia is caused by arteriosclerosis which is a
gradual narrowing of the arteries induced by plaque build-up
(McCance & Heuther, 2014). Mr. Smith’s angiography and
requirement of the usage of IV clot dissolvent supports this
analysis.
Reversible cell injury is capable when oxygen is supplied
back to the cell within a certain amount of time. Irreversible is
when the cell has structural changes, mainly damage to the
nucleus and has become necrotic (McCance & Heuther, 2014).
Rather a cell’s injury is reversible or irreversible depends on
factors such as length of time the damage has taken place and
the type of damage. Cells can also adapt to damage and still
remain functioning (McCance & Heuther, 2014).
The pathophysiological changes that occur to the heart

2. during an MI can be detrimental, it is important to ensure quick
diagnostic confirmation of an acute MI to prevent further
complication and death. Within 1 minute the heart becomes pale
and is not able to contract as efficiently (McCance & Heuther,
2014). In 3-5 minutes. the section of the affected heart stops
contracting this causes mitochondria oxygenation to decrease
which decreases the production of ATP (McCance & Heuther,
2014). Cellular swelling begins along with the loss of integrity
to the plasma membrane (McCance & Heuther, 2014). With the
integrity of the plasma membrane compromised the sodium-
potassium pump and the sodium-calcium exchanges fail
resulting in cellular death if oxygen supplies are not returned
(McCance & Heuther, 2014).
Subjective findings for MI are patient complaints of
shortness of breath. Chest pain can be described as having
severe pain or as though a lot of pressure is “sitting” on the
chest (McCance & Heuther, 2014). Some patients complain of
nausea and vomiting along with pain described as “shooting” in
jaw or left arm (McCance & Heuther, 2014). Objective data for
diagnosis of an MI are EKG findings and cardiac enzyme results
(McCance & Heuther, 2014).
Discussion #2
Coronary heart disease (CHD) is one of the leading causes of
death and accounts for nearly 25% of all deaths in America
(McCance & Huether, 2014, p. 171). Myocardial infarction
(MI) results from decreased blood supply to the heart that
causes damage to heart tissue from an inadequate supply of
oxygen (McCance & Huether, 2014, p. 171). There are two
types of risk factors associated with CHD and MI: non-
modifiable and modifiable. Conventional or non-modifiable
risk factors consist of demographics such as age, gender, and
family history (McCance & Huether, 2014, p. 1149). The
modifiable risk factors associated with CHD include conditions

3. such as dyslipidemia, hypertension, diabetes and insulin
resistance and lifestyle factors such as smoking, obesity, diet,
and activity level (McCance & Huether, 2014, p. 1149).
In the provided case study, Mr Smith has sustained
ischemic cell injury. Ischemic cell injury is categorized by lack
of oxygen, through reduced blood supply, that causes the
destruction of the cell structure and the cell membrane
(McCance & Huether, 2014, p. 55). The lack of adequate
oxygen is called hypoxia, the most common cause of ischemia,
and is the number one cause of cellular injury (McCance &
Huether, 2014, p. 56). Hypoxia results from a reduction in
oxygen that can be related to a number of conditions including
anemia, respiratory disorders, and cardiovascular diseases
(McCance & Huether, 2014, p. 56).
Cell injury can be either reversible with the possibility
of recovery or non-reversible that results in cell death.
Reversible cell injury responses include loss of adenosine
triphosphate (ATP), cellular swelling, ribosomal detachment,
and autophagy of the lysosomes (McCance & Huether, 2014, p.
55). Irreversible cell injury is called the “point of no return”
and is considered a biochemical puzzle due to the exact
mechanism of action responsible for the cell’s transition from
reversible to non-reversible remaining undecided (McCance &
Huether, 2014, p. 55). Factors exist, such as nutritional status,
that play a role in the cell’s ability to recover and to the extent
of damage that occurs from the injury (McCance & Huether,
2014, p. 55).
The pathophysiological changes that occur during an MI
began less than one minute after reduction of myocardial blood
supply (McCance & Huether, 2014, p. 58). Cardiac cells are
able to survive ischemic conditions for approximately 20
minutes prior to cell death however ECG changes are visible as
early as 30-60 seconds after hypoxia occurs (McCance &
Huether, 2014, p. 1160). Immediately after reduced blood flow
the affected myocardial tissue becomes cyanotic and all oxygen
reserves are used rapidly leading to the use of anaerobic

4. metabolism (McCance & Huether, 2014, p. 1159). The use of
glycogen as an energy source is inadequate to meet the total
energy requirements of the myocardium resulting in acidosis
from electrolyte imbalances (McCance & Huether, 2014, p.
1159). These imbalances make the myocardial tissue vulnerable
to the effects of lysosomal enzymes, which further reduces the
contractile function and impulse conduction and leads to heart
failure (McCance & Huether, 2014, p. 1159).
As ischemic damage occurs, the first symptom is
typically acute, sudden onset of severe chest pain that has been
described as heavy and crushing, like there is “an elephant on
my chest”, with radiation reported to the jaw, neck, back,
shoulder, and left arm (McCance & Huether, 2014, p. 1160).
Some reports of atypical presentation of MI, usually associated
with the elderly or those with diabetes, include no pain, nausea
and vomiting, or uncontrollable indigestion (McCance &
Huether, 2014, p. 1160). Objective changes that can be
observed include a temporary increase in heart rate (HR) and
blood pressure (BP) as the body attempt to compensate,
abnormal extra heart sounds resulting from left ventricular
dysfunction, cardiac murmurs related to valvular insufficiency,
respiratory congestion including percussion that is dulled and
inspiratory crackles at the lung bases, and skin that is cool and
clammy as the result of peripheral vasoconstriction (McCance &
Huether, 2014, p. 1160).
Study Questions for Exam #3
Base your answers on class notes (for some data, this is more
up-to-date than the readings) and on the readings posted to
blackboard. Their names are Khan-Bangladesh and Karadjis –
Vietnam. Your answers on the exam should be quite thorough
and you may bring a page of notes.
1. What is the condition of labor like in Bangladesh today,

5. especially in the garment industry? Consider wages, working
conditions, hours worked, gender of workers, representation by
unions.
2. Contrast this with the condition of labor in Vietnam.
3. Vietnam considers its economic system “market socialism”
that emphasizes the improvement of social welfare. How does
Vietnam fare on various social indicators and social spending?
How does this compare with other countries?
4. Contrast this with social indicators in Bangladesh and China.