Hiroshi experienced a heart attack on a flight from London to Chicago. He was admitted to the hospital where tests showed he had a blocked coronary artery and irregular heart rhythms. A stent was placed in his artery, but some heart muscle tissue was permanently damaged. He was given medications and had a pacemaker implanted to regulate his heartbeat and breathing, as his heart could no longer meet his body's demands on its own after the damage.

1. Hiroshi's business meeting ran late, and he is rushing through in the meantime, he closes his eyes
and tries to focus on the Heathrow Airport to make sure he's in time to theck his luggage
meditation techniques he has learned to ease himself into a for his fight home to Chicago. He
arrives at the ticket counter more relaxed state. to face a long, slow-moving line, but he finally
makes it to the Hiroshi is a 49 -year-old man with a high-stress engineerfront and gets his
boarding pass. The clerk tells him to hurry: he ing job. He has no personal history of health
problems, but his only has thirty minutes to make it through security and to his grandfather died
of a sudden heart attack at the age of 70 and gate for boarding. his father died of the same
condition at the age of 60 . Hiroshi is Without his luggage Hiroshi is able to move more quickly,
having a heart attack. What causes a heart attack, and what are but the security line, as usual, is
long. He places his laptop in its complications? You will learn the answers to these questions a
bin and pushes it toward the screener. He walks through the and others in this chapter on the
circulatory system, which emmetal detector, collects his computer, and runs down the con-
phasizes the crucial role of the heart in maintaining the supply course to make his flight. By the
time he gets in the boarding of oxygen to the body. line, he is gasping for air, and thinks to
himself, "l am really out Once the plane is airborne, the flight attendant offers of shape. I should
have been able to run from security to the drinks. Hiroshi asks for a cup of hot tea, and takes a
Xanax tablet gate without getting this short of breath." to relax, as the meditation techniques
have not worked so far. Hiroshi boards the plane, finds his window seat, and col- He feels
nauseated and doesn't understand why he is sweating lapses into it, wishing he had a bottle of
water to drink. He so much. He declines the meal, turns up the air at his seat, and leans his head
against the window, watching the last of the lug. sleeps fitfully until the plane lands in Chicago.
He slowly makes gage being loaded into the belly of the plane. His breathing is his way through
O'Hare Airport to the baggage claim area, feela little easier, but his chest feels tight and he is
experiencing a ing even more short of breath than he did in London. He gets burning sensation.
He decides to take one of the pills that his his luggage and sits down to rest before going outside
to be doctor prescribed to help him relax while flying, but it will have picked up by his wife,
Takara. to wait until the flight attendant offers him something to drink. The next thing Hiroshi
knows, Takara is standing in front of Hiroshil begins to feel better and wants to go home, but he
him saying. "Hiroshi, I was waiting for you outside. When you still has trouble breathing when
he gets out of bed to walk, and did not come out, I parked in the garage and came in. Why are the
nurse is concerned because his pulse rate is 45 . She tells you just sitting here? You look awful.
You are gray and sweating. him, "When you are lying in bed, a rate of 45 is fine, but when
What's wrong?" you get up to exercise, your heart rate needs to increase to pro"I don't know,"
replies Hiroshi, "I haven't felt good since vide you with the oxygen you need for exertion, Your
heart is I arrived at the airport in London. Maybe I'm coming down not doing this so I am going
to have to let Dr. Morris know." with the flu. I am really short of breath," he says as he begins _
Dr. Morris returns to see Hiroshi. After looking at the most to cough. recent electrocardiogram,
he tells Hiroshl, "You have a comTakara says, "I don't like the way you look, Come, get into
plete bundle branch block; there is a blockage in the pathway the car. I am going to take you to
the emergency room." that sends electrical impulses from your atria to your ventri"No, just take
me home so I can go to bed. I am really tired," cles, which slows the pumping action of your
ventricles. I will argues Hiroshi. put you on this afternoon's schedule for the insertion of a
pace"Absolutely notl We are going to the hospital," Takara re- maker into your chest wall. The
pacemaker will adjust your sponds firmly. heart rate to meet the demands of your body. You will
experiAs Takara provides insurance information to the admitting ence less shortness of breath,

2. and you'll feel better when you clerk at the hospital, the nurse measures Hiroshi's vital signs, get
out of bed." listens to his heart and lungs, hooks him up to a cardiac moni- Hiroshi experienced a
heart attack while on a plane from tor and nasal oxygen, and starts an intravenous line. The nurse
London to Chicago. His symptoms were atypical, with none calls Dr. Morris, reporting that
Hiroshi has an irregular heart of the crushing chest pain that most men experience during a rate,
an extra heart sound known as a gallop rhythm, and flu- myocardial infarction. The length of
time that passed between id in his lungs. While waiting for Dr. Morris to arrive, the nurse the
heart attack and treatment caused permanent damage to draws some blood and sends it to the lab.
Hiroshi's heart. A stent was inserted, which diminished lurther Dr. Morris arrives, and after
greeting Hiroshi and Takara damage. Hiroshi experienced atrial fibrillation, an arrhythmia he
looks at the readings on the monitor and listens to Hiroshi's of the atria, and a complete bundle
branch block so that no heart and lungs to confirm the nurse's findings. As he places his atrial
impulses could get to the ventricles. Because Hiroshi's stethoscope around his neck, he tells the
couple that Hiroshi ventricles contracted at such a slow rate that he could not rehas experienced a
myocardial infarction, or heart attack, while sume his normal activities, he had a pacemaker
inserted into on the plane and that Hiroshi's left coronary artery is blocked. his chest wall and
connected to his ventricles. The pacemaker "I need to perform a cardiac catheterization to place a
stent will maintain a steady heart rate and will increase his heart rate around the blockage, but
because the injury occurred several when Hiroshi needs more oxygen sent to the organs of his
body. hours ago, some of Hiroshi's myocardial tissue may already Although the pacemaker will
alleviate fotigue, the ventricles have died. The cardiac catheterization will help us determine of
Hiroshi's heart have been damaged to the extent that they the status of his cardiac function. In the
meantime, the nurse are no longer able to meet the cardiac output demands of his will give
Hiroshi some intravenous medications, morphine to heart, even with medications to stimulate
contraction. Fortuease his breathing and help him relax, and Lasix, a diuretic to nately, Hiroshi's
vital signs have remained within normal limits, remove the excess fluid from his body." so he
does not have to worry about hypertension at this time. Following the cardiac catheterization, Dr.
Morris returns to He will be given medication to control his atrial fibrillation or A. Hiroshi's left
coronary artery is blocked. What effect will this have on the myocardium of his heart? B. Why
would the inability of Hiroshi's left ventricle to effectively pump blood cause him to experience
shortness of breath and peripheral swelling from excess fluid (edema)? C. The sinoatrial ( SA )
node, the pacemaker of the heart, normally generates 80-100 action potentials per minute. Given
what you know about the ability of autorhythmic fibers to spontaneously generate action
potentials, how might Hiroshi's atrial fibrillation prevent the SA node from maintaining a normal
rate of atrial contraction? D. Hiroshi is diagnosed with a complete bundle branch block, pre-_ F.
Hiroshis left ventricle does not empty with each contraction, causventing impulse conduction
from his atrioventricular (AV) bundle and ing blood to back up through his circulatory system.
How would this the Purkinje fibers of his ventricles. How does this blockage affect co- affect his
preload and afterload? ordination of contractions of the heart chambers? G. Hiroshi experienced
shortness of breath prior to his hospitaliza. E. Hiroshis atrial fibrilation and bundle branch block
show up on his tion. He was given a diuretic that promotes Na excretion in urine. How. ECG
tracing. Which components of his ECG tracing might be different could a decrease in the
circulating level of Na" affect contractility of than those from a normal ECG? the heart?