Identifying Diseases And Condition In Peta’s Case Study

Symptoms of Peta’s condition

Peta is a retired, 65-year-old woman, who has been drinking a couple of alcoholic beverages every night whilst relaxing with her husband. She has also started smoking again, which she has not done since prior to her marriage 40 years ago. In fact, what started as a couple of cigarettes every day has now become a packet a day.

More recently, her friends have noticed that she stumbles quite often, forgets things, is moody, and is flushed in the face almost all the time. When questioned about the amount she drinks, she denies excessive use. She states that while she has 3–4 glasses of vodka every night. However, because she has noticed that she no longer gets the same pleasurable feelings from a couple of glasses as before, she doesn’t think the alcohol affects her as much as her friends suggest.

Further, Peta has also lost interest in many things she once enjoyed; dancing, going to the movies, and her art class. She cries at the drop of a hat, finds it difficult falling asleep at night, which led her to drink even more—often until she passes out. She has no energy to get up and just wants to stay in bed all day.

After several unsuccessful attempt, her husband, Ken, finally could convince her to seek professional help about her condition. At the medical clinic, the GP listens to Peta’s signs and symptoms, conducts a thorough physical examination, and then prescribes a benzodiazepine (Xanax) and a selective serotonin reuptake inhibitor (Zoloft) for her. Peta is also given information on counselling and is referred to a professional counsellor to talk through her problems and help her with finding adequate coping strategies.

Based on the scenario outlined above, identify two diseases/conditions Peta has and by stating relevant facts from the case study, justify your answer.

Based on the given scenario of Peta, the two diseases that can be identified are dementia and depression.

Dementia refers to an umbrella term for several types of symptoms. These symptoms affect the cognitive functioning of a person such as their ability to think, their memory, and their ability to provide a logical explanation. The early indications of dementia are forgetfulness, difficulty in making a decision, being moody and confused all the time, having issues while speaking or writing something, and having a flushed face. In the given case study of Peta, the symptoms that indicate dementia is she stumbles quite often, forgets things, is moody and is flushed in the face almost all the time.

The other condition that has been identified is depression. Depression is a type of mental disorder that is identified by persistent sad moods and not having an interest in anything. It impacts how a person feels, thinks, and behaves and can contribute to a range of mental and physical difficulties. It is also known as major depressive disorder or clinical depression. Regular daily tasks may be difficult, and one might think as if life is not worth it. The fact that state that Pate is having depression is that she has also lost interest in many things she once enjoyed such as dancing, going to the movies, and her art class. She cries at the drop of a hat and finds it difficult to fall asleep at night, which led her to drink even more—often until she passes out. She has no energy to get up and just wants to stay in bed all day.

Identifying Peta’s medical conditions

For one of the diseases/conditions you have identified in Question 1/1, link the pathophysiology to the characteristic signs and symptoms of the disease.

The basic pathophysiology of major depressive illness is not well understood. A disruption in the activity of serotonin (5-HT) in the central nervous system appears to be a crucial element in Therapeutic And Preclinical Investigations. Norepinephrine (NE), dopamine (DA), glutamate, and brain-derived neurotrophic factor (BDNF) are among the additional neurotransmitters involved. Peta has an issue of consuming alcohol. There is also a substantial correlation between heavy alcohol consumption and depression. Alcohol has a depressant effect. It has the potential to upset the chemical equilibrium of the brain, influencing the ideas, emotions, and actions – and, in some cases, the long-term mental wellbeing of the person. This is due, in particular, to neurotransmitters, which are molecules that aid in signal transmission from one neuron in the brain to another. The functioning of the brain suffers when a person consumes more alcohol. And, irrespective of the person’s mood, increased alcohol use may cause negative thoughts to dominate over, resulting in a detrimental influence on mental wellbeing. Alcohol has been related to aggressive behavior, and some people say that when they drink, they get furious, aggressive, worried, or depressed. 

For the disease you have selected in Question ½, describe the mechanism of action of the relevant drug Peta is prescribed with and explain how these drug actions help mitigate some of her symptoms. In your answer, relate the drug’s mechanism of action to the pathophysiology of the disease. 

Peta has been prescribed with Zoloft which is a selective serotonin reuptake inhibitor. It is used to cure major depressive disorder, social anxiety disorder, and a variety of other mental illnesses. Zoloft preferentially suppresses serotonin (5-HT) absorption at the presynaptic neuronal membrane, enhancing the activity of serotonin. It leads to an increase in the amount of serotonin at the synapse in the Central Nervous System. It causes a cascade of physiological alterations linked with increased neuro transmission of serotonin. These modifications are responsible for the antidepressant activity of this drug. It has been hypothesized that mental disorders like depression occur due to an imbalance of serotonin. 

Peta’s family was happy with the management plan established by the doctor as Peta was progressing quite well. Unfortunately, however, on a quiet Sunday morning, Peta tripped and fell, which resulted in excruciating pain in her hip. She could not even get up; her husband called the ambulance and tried to comfort her until they arrived. She was taken to hospital, where the X-ray confirmed that she suffered hip fracture. The examination also revealed that although the fracture  had not breached the integrity of the skin, it resulted in numerous fragments of bone at the site of the injury. A bone density test was also completed, which indicated that Peta had a T-score of −2.7. 

Interpret the result of the bone density measurement, indicate what reading would be considered physiological, and name the condition Peta’s finding is associated with.  

Pathophysiology of depression associated with alcohol

T scores are tests that tell about bone density. Bone density examinations determine the strength of the bones. These tests are used by doctors to check for and detect osteoporosis. A T-score indicates to what extent the bone density of Peta differs from that of a healthy adult of around 30 years of age. A T-score that shows the value of -1.0 or above indicates normal bone density. The T score between -1 to -2.5 indicates that the person has a low level of bone density or osteopenia. A T-score of -2.5 or lower indicates osteoporosis. As Peta’s T-score is 2.7 it means that she has osteoporosis. Osteoporosis affects the bones and makes them weak and fragile, so brittle that even minor stressors like leaning over or coughing can result in a fracture. Most of the fractures which are related to osteoporosis occur in the hip, wrist, or spine. Bone is a living tissue that is continuously breaking down and being rebuilt. Whenever the formation of fresh bone does not maintain with the degradation of old bone, osteoporosis develops.

Describe the aetiology and pathogenesis of the disease you specified in the previous question. 

The etiology of osteoporosis includes taking steroids that are prescribed to cure a variety of inflammatory disorders, such as rheumatoid arthritis. They can have an impact on bone formation by lowering calcium absorption from the gut and boosting calcium excretion through the kidneys. Lack of estrogen from the body, lack of exercise, and a diet that does not include an adequate amount of calcium and Vitamin D can also cause osteoporosis. If a female undergoes early menopause or surgery in which one or both ovaries are removed, a female is more likely to suffer from osteoporosis. This is since they induce the body’s production of oestrogen to drop substantially, hastening the rate of bone loss. The other aetiological factors of this disease are heavy smoking, heavy consumption of alcohol, and family history. Drinking excessive amounts of alcohol impairs the ability of the body to produce bone. It also raises the likelihood of fracturing a bone as a consequence of a fall.

Osteoporosis can develop as a result of (1) failing to reach optimum bone mass and (2) increased resorption of bone and decreased bone production throughout remodeling. All of these mechanisms are expected to lead to osteoporosis in varied proportions.

Name the structure where Peta’s fracture occurred and—based on the information provided and considering her history—characterize the fracture and describe the most likely link between the condition you named under Question 1/4 and her current injury. 

Peta’s X-ray confirmed that she suffered a hip fracture. The fracture did not compromise the skin’s integrity, it resulted in multiple bone fragments at the site of the injury. A hip fracture is a crack in the hip joint’s thighbone (femur).  Osteoporosis is the condition in which the bone density becomes very less, which makes the bones very weak and prone to breakage.  The bones become thinner due to the loss of calcium.   Osteoporosis increases the chances of hip fracture if a person falls.  

Rei is a 53-year-old female, who decides to visit her GP as she has been feeling tired a lot. She often feels thirsty and has noticed she needs to urinate more frequently. The GP comments on Rei’s skinny appearance and asks if she had any weight changes recently. Rei realises she has been buying smaller sized clothes recently even though she had not experienced rapid changes in weight previously. The doctor examines Rei and notes she has a sweet, fruity odour to her breath. The doctor also orders both urine and blood tests for Rei, which gave the following results:

Mechanism of action of Zoloft

Assessment/Examination	Results
Urine dipstick test – glucose	+++
Urine dipstick test – ketones	++
Plasma glucose (fasting)	18 mmol/L
Bicarbonate	12.5 mEq/L
Arterial PaCO2	29 mmHg
Blood pH	7.25
Plasma insulin	< 5 mU/L
HbA1c	9%

After diagnosing the condition, her GP helps Rei to develop a management plan. 

Name the underlying disease Rei is suffering from and justify your answer using two pieces of information from the clinical picture to support your conclusion. 

The underlying disease that Rei is suffering from is Type 1 diabetes. Type 1 diabetes is an autoimmune disease in which the immune system of the own body destroys the cells present in the pancreas which are responsible for making insulin. Insulin is a hormone that controls the glucose levels in the blood circulation of a person. Two pieces of information from the case study that supports the diagnosis are she is feeling excessively thirsty and has a sweet, fruity odor to her breath. These are symptoms of Type 1 diabetes.

Evaluate Rei’s laboratory findings and name the acute complication Rei was suffering from when she visited her GP and explain your reasoning. 

After evaluating the laboratory findings of Rei, it was found that the urine dipstick test was positive for glucose and ketones. For the high amount of glucose in the urine, the most common cause is diabetes. In diabetes, the body is not able to either make enough amount of insulin or the cells are not able to utilize the insulin. This leads to the accumulation of glucose in the blood. The symptoms in Rei that are indicative of it are excessive thirst, blurry vision, and tiredness. A ketone test can alert a person to a potentially fatal diabetes condition known as diabetic ketoacidosis, or DKA. A significant concentration of this compound in the blood can indicate that a person has very high blood sugar. 

Discuss the pathophysiology behind the complication. For this answer, ensure you relate to the condition identified earlier. 

Diabetes mellitus type 1 expresses primarily in three different stages. Stage 1 generally shows no symptoms and is distinguished by normal fasting glucose, normal glucose tolerance, and the development of more than or equivalent to two pancreatic autoantibodies. The development of two or more autoantibodies produced by the pancreas, along with dysglycemia: reduced fasting glucose (glucose of 100 to 125 mg/dl) or altered glucose tolerance (2-hour PG of 140 to 199 mg/dL) or a hemoglobin A1c of 5.7 percent to 6.4 percent, are stage 2 diagnostic criteria. Individuals continue to be asymptomatic. In stage 3, diabetes or high blood glucose with clinical symptoms and two or more autoantibodies of the pancreas are present.

The development of signs in adults with Type 1 diabetes mellitus can be more unpredictable than in children.

The beta cells of the islets of Langerhans of the pancreas synthesize the insulin. It is released as a response to the glucose stimulus. It is an autoimmune condition that occurs when the immune system damages cells in the pancreas which are responsible for making insulin. This causes a complete deficit of the hormone, requiring patients to rely on external supplies for the rest of their lives. Type 1 diabetes is frequently thought to be a condition with a quick onset; nevertheless, its emergence is a much gradual process requiring gradual immunological impairment.

Peta’s case study and bone density

Possible long-term complications of Rei’s present condition are nephropathy and consequent renal failure. Discuss the link between Rei’s underlying disease and nephropathy.

Diabetes can result in neuropathic pain, a type of injury to the nerve. High levels of sugar in the blood might harm the nerves all over the body. Diabetic neuropathy mostly affects the nerves in the lower limbs. The symptoms of diabetic neuropathy can vary from discomfort and loss of limbs in the legs and feet to difficulties with the digestive system, urinary tract, arteries and veins, and heart, relying on the nerves that are affected. Some individuals just have minor symptoms. Diabetic neuropathy, on the contrary, can be highly painful and life-threatening for certain patients. Extremely high level of sugar in the blood destroys nerves and impairs their capacity to transmit messages, resulting in diabetic neuropathy. High blood sugar also affects the lining of the small blood arteries (capillaries) that deliver oxygen and nutrients to the nerves. 

Discuss the significance of Rei’s HbA1c reading. 

HbA1c is an essential predictor of long-term glycemic control since it might represent the previous two to three months’ aggregate glycemic record. HbA1c is not only a valid indicator of chronic hyperglycemia, but it also corresponds well with the probability of long-term complications related to diabetes. HbA1c readings for diabetics provide a good indication of how well their diabetes is managed. The A1c test findings are provided as a percentage. The test outcome indicates how much hemoglobin that glucose has attached to the blood. The HbA1C value of Rei is 9% which indicates that she has diabetes.

Rei’s aunt has been suffering from diabetes mellitus and has been using insulin to manage her condition for 20 years. 

Explain the reasons diabetic patients (may) require exogenous insulin administration and discuss the need for using short- and long-acting preparations. In your answer, explain why the administration of insulin tablets would be useless. 

When the food is digested, the body changes the food into glucose which is a type of sugar. Insulin permits glucose to reach all of the body’s cells and be utilized as energy. When a person is having diabetes, the body does not make enough amount of insulin or is not able to utilize the insulin in an efficient way. As a result of this, the glucose starts accumulating in the blood instead of entering the cells. When there is too much glucose in the blood circulation and not enough in the cells it can result in some very serious health issues. Everyone with Type 1 diabetes like Rei needs to take insulin so that they can keep their blood sugar under control. The main aim of taking insulin is to keep the level of glucose within the normal range as much as possible. When the blood sugar is under control it helps the person healthy.

Short-acting insulin aids in the reduction of blood glucose spikes produced by eating or drinking. It is frequently taken prior to a meal, snack, or drink that contains carbohydrates. Short-acting insulin lowers the level of glucose in the blood within 30 minutes, therefore one should inject themselves 30 minutes before eating. It is most effective 2 to 5 hours after injection and lasts 6 to 8 hours. Long-lasting insulin provides insulin to the body whether the person consumes food or not. It helps in keeping the glucose level in the blood stable overnight or between meals.

Insulin cannot be taken as a pill. If we ingested insulin, digestive enzymes in the stomach would break it down before it reached the bloodstream.

Rei’s aunt has been feeling tired all the time recently despite the successful management of her diabetes. She has also noticed that she has stiff & sore wrists. Intriguingly, the stiffness she experiences in her fingers as well is particularly severe when she goes to have her morning cigarette. She also finds that her fine finger movement when rolling her cigarettes have become much harder. Her GP completes a physical exam and notes that her joints are swollen and warm to touch.

Name the musculoskeletal disorder Rei suffers from, justify your answer, and identify a risk factor in her history that may have contributed to the aetiology of the disease you specified. 

The musculoskeletal disorder that Rei suffers from is Rheumatoid arthritis. In the given case study, Rei has stiff & sore wrists. Intriguingly, the stiffness she experiences in her fingers as well is particularly severe when she goes to have her morning cigarette. She also finds that her fine finger movement when rolling her cigarettes has become much harder. Her joints are swollen and warm to touch.  One of the risk factors identified in her history is Type 1 diabetes.

Individuals who have type 1 diabetes are more likely to acquire Rheumatoid arthritis, and vice versa. Type 1 diabetes is an autoimmune condition in which the body’s own immune system kills the cells that produce insulin by mistake. It indicates that a person who has one autoimmune condition has a higher likelihood of having another one at some stage in life.

Compare and contrast the aetiology of Rei’s joint disease with the other joint disease we covered in BIOL122. In your answer, name both diseases and describe two similarities and two differences.

Osteoporosis is the condition in which the bone density becomes very less, which makes the bones very weak and prone to breakage whereas Rheumatoid arthritis is an auto immune condition that causes inflammation of joints. Osteoporosis is caused when the body fails to replace the old bones with new ones whereas Rheumatoid arthritis is caused when the immune system of the own body starts attacking the healthy joints.

The similarities between both the diseases make the bones weak and brittle and more prone to fractures. Both the diseases can make performing daily activities difficult

Rei’s work colleague, Kurt, is a 53-year-old father, who has worked as a gardener all his life. He has been diagnosed with stage IVA melanoma. Kurt underwent removal of the melanoma on his left forearm and a nearby lymph node dissection 7 weeks ago. He has been receiving immunotherapy for his melanoma which has not been successful and therefore he has been placed on chemotherapy.

Kurt has been experiencing weight loss over the last 2 months as well as a persistent cough and shortness of breath. A CT scan reveals several, well circumscribed, rounded structures in the periphery of his lungs. A lung biopsy is performed, which confirms the presence of melanoma cells in the structures observed on the CT image.

Discuss the significance of Kurt’s CT and histology findings.

For its better spatial, temporal, and contrast clarity and absence of overlaying of surrounding organs, CT scanning is the technique of selection for detecting and monitoring lung metastases. It has been demonstrated to be more sensitive than chest radiography (CXR) in detecting lung metastases. CT scanning is done with a multislice approach, and no intravenous contrast is used to identify lung metastases. A lung biopsy is a process that involves removing specimens of tissues in the lungs (either with a specific biopsy needle or during surgery) to evaluate the presence of lung illness or cancer.

A CT scan indicates many well-defined, spherical structures in his lungs’ perimeter. A lung biopsy confirms the presence of melanoma cells in the structures visible on the CT picture.

Further laboratory testing has indicated a p53 gene mutation in Kurt’s melanoma cells. Explain the possible link between Kurt’s p53 mutation and his melanoma, and considering Kurt’s profession, name a possible environmental factor that may have caused his mutation. 

Metastatic melanoma is a significant health issue. Whereas the P53 tumor suppressor gene is often mutated in many different cancers, mutational suppression of P53 in melanoma is rare, and wild-type P53 is routinely found at elevated amounts. Furthermore, in contrast to other malignancies, the expression of wild-type P53 in melanoma tends to rise with tumor development and extent of invasion and is linked with poor prognosis.

There are numerous mutation in the gene that have been found to have a significant relationship with the development of cancer. The bulk of these mutations take place in three types of genes: proto-oncogenes, tumour suppressor genes, and DNA repair genes. A variation in one of these categories, or any combination of them, can work together to cause a neoplastic disease. In a typical process of cell division, proto-oncogenes operate as regulators for critical development, whereas tumour suppressor genes serve as antagonistic growth regulators. The p53 tumour suppressor gene is engaged in the arrest of the cell cycle and programmed activation which induces the death of a cell. Mutations in the p53 gene have been found in 50% of all human malignancies and in nearly all skin cancers. p53 encodes a 53-kDa phosphoprotein that is engaged in the transcription process of genes and regulation of the cell cycle through synchronizing transcriptional modulation of regulatory genes.

Kurt has worked as a gardener for whole his life. His occupation as a gardener has made him vulnerable to melanoma which is the deadliest form of skin cancer. 

Twenty-one-year-old Shane has long been suffering from asthma and is now experiencing an asthma attack while taking an afternoon walk with his sister. It is a cold, windy, early spring weekend. She complains of acute shortness of breath and has audible wheezing, episodic cough, and chest tightness with itchy red watery eyes and a stuffy, runny, itchy nose. These symptoms become worse within 5 minutes. Her sister called 000, and paramedics promptly attended to Shane, who was fully conscious, appeared wide-eyed and frightened, and unable to breathe effectively. She was immediately transferred to the nearest hospital for full respiratory function assessment and treatment of acute asthma.

A physical exam reveals a heart rate (HR) of 120/min and a respiratory rate (RR) of 38/min with signs of accessory muscle use. Chest auscultation reveals decreased breath sounds bilaterally, with inspiratory and expiratory wheezes. Shane is coughing up small amounts of sputum and has an arterial oxygen saturation of 90%.

Nebulised salbutamol, oxygen by facial mask, and systemic corticosteroid were administered. A second small-volume nebuliser treatment was ordered 20 minutes later. Chest auscultation revealed diminished wheezes; RR was 24/min at this time, and HR was 102/min. Over the next 24 hours Shane showed steady improvement and was discharged for follow-up with her local GP to review her asthma action plan and change any medications as needed to help prevent future exacerbations.

Choose two risk factors from the case study above and explain how they may have contributed to the pathogenesis of Shane’s current acute asthma attack. In your answer, discuss the role of histamine in Shane’s present condition.  

Asthma is a disorder in which there is constriction and inflammation in the respiratory airways, causing an excess amount of mucus to be produced. This can cause breathing problems, resulting in coughing, a whistling sound (wheezing) as the person exhales, and shortness of breath. Asthma is a mild annoyance for most individuals. For others, it can be a severe issue that disrupts everyday routines and may result in an asthma attack which can be life-threatening.

The two risk factors in the case of Shane are cold weather and the spring season. Cold weather is a very common trigger for aggravating asthma attacks. It can be hazardous for those individuals who have asthma. A person who suffers from asthma has their airways inflamed all the time. This makes the airways very narrow which makes it very difficult for the lungs to get air. This also produces an excessive amount of mucus. When someone who has asthma breaths in the air that is cold and dry, the muscles within begin to spasm while still attempting to retain the airways open. This stimulates the wall of the airways, even more, resulting in coughing, wheezing, and shortness of breath. Cold air can aggravate symptoms of asthma and flare-ups, particularly if it is dry. The dryness in cold air can cause problems with breathing for many persons with asthma. Cold air combined with windy circumstances might also cause symptoms. In general, the more extreme asthma, the more likely it is that cold air will harm the person.

The other risk factor in Shane’s case is the spring season. The allergens released in the spring season led to the aggravation of the asthma attack. Tree pollens, mould spores, and grass have the ability to aggravate and constrict the airways of persons who are susceptible to these environmental stressors during the spring. Wheezing, shortness of breath, chest tightness, and coughing are all classic signs of an asthma attack.

Histamine is a natural substance that the body produces. It has a variety of purposes, notably serving as a relay messenger among different regions of the immune system. Allergies are connected with histamine hyperactivity. Histamine works with the natural defense mechanisms of the body to keep an individual safe from hazardous toxins. Asthma and symptoms of allergy can emerge when the body reacts badly to something that is not very dangerous but has triggered the immune system. Once a person is exposed to allergens, the immune cells known as mast cells and white blood cells identified as basophils generate histamine. The allergic reaction starts when histamine is generated. It in case of asthma histamines produce bronchoconstriction and production of mucus.

Explain the mechanisms of action of salbutamol in the treatment of acute asthma and describe its benefit in Shane’s condition.

Salbutamol is an agonist of the beta-2 adrenergic receptor that is indicated to cure asthma.

Salbutamol has a superior action on beta2-adrenergic receptors when compared to isoproterenol, according to in vitro and in vivo pharmacological investigations. When beta2-adrenergic receptors present on the smooth muscles of the respiratory airways get activated, it leads to stimulation of adenyl cyclase, and the intracellular quantity of cyclic-3′,5′-adenosine monophosphate rises (cyclic AMP). This rise in cyclic AMP activates protein kinase A, which suppresses phosphorylation of myosin and decreases intracellular ionic calcium levels, leading in relaxation. The smooth muscles present throughout the respiratory airways, from the trachea to the terminal bronchioles, are relaxed by salbutamol. Salbutamol works as a functional antagonist to ease the airway regardless of the spasmogen, guarding against every bronchoconstrictor threats. Elevated levels of cyclic AMP have also been linked to the suppression of mediator production from mast cells present in the airway.

Discuss the link between Shanes elevated HR and RR and her acute asthma attack.

Severe asthma causes an increase in the concentration of carbon dioxide in the blood. It reduces the flow of oxygen in the blood. As a result, to compensate the heart beats faster thus increasing the heart rate. One of the causes an individual breathe more quickly than normal is to draw in more amount of oxygen. The body’s oxygen content might be too little, or its level of carbon dioxide may be too high. The body attempts to compensate by breathing more rapidly. Certain disorders, such as asthma, which impairs the lungs, can cause tachypnea by lowering the levels of oxygen in the blood or increasing carbon dioxide levels.

Shane’s grandmother, Maria, is a 67-year-old retired, clinically obese woman, who lives with her life partner, Robin. She enjoys sitting down to a movie every night with a large packet of salt and vinegar chips or a tub of cookies and cream ice cream. She has always loved a glass or two of wine with dinner but now figures she can have a few more since she no longer has to get up for work. Maria doesn’t like to exercise; her only form of exercise is walking around Coles on Friday whilst doing her weekly shopping. Her sister has asked her to join her walking group on numerous occasions, but Maria would rather stay home and bake. Maria’s mother moved in with her many years ago when her father passed away from a heart attack at the age of 60. Her mother isn’t in the best of health: she has type II diabetes and hypertension, which are under control.

One day Maria decides to visit her neighbour, taking with her a batch of freshly baked cookies. Whilst walking to her neighbour’s house, she notices that she is short of breath and is feeling a slight pain in her chest, but when she sits down, she feels fine, so she dismisses it once again, putting it down to her poor fitness. However, on her way home she begins to feel light-headed and weak and feels like she is going to be sick. She notices that she has been feeling like this quite a lot lately, even when resting in the evening, so she decides to make an appointment with her GP for later in the week.

At the medical clinic, the GP takes Maria’s blood pressure reading. It has been elevated on a number of occasions, and today is no different—the reading shows 140/95 mmHg. The GP prescribes an ACE inhibitor and tells Maria she really needs to make some lifestyle changes. He writes a referral for her to see a cardiovascular specialist for an ECG and a coronary angiogram to determine why Maria has been short of breath and unwell.

One day, whilst waiting for her results, Maria starts to feel more nauseous and dizzier than usual. She starts to feel clammy and sweaty, and her face seems grey in colour. The chest pain returns but now feels like a crushing pain, and she can’t breathe. Robin dials 000, and she is rushed to hospital. An ECG shows that Maria has an ST elevation, and a blood test indicates that she has high levels of cardiac-specific troponin in her blood. Maria is given heparin intravenously as well as an anti-platelet and a fibrinolytic drug. She is taken into surgery, where a coronary angioplasty is performed.

Name the condition Maria was suffering from when she was rushed to hospital and discuss two clinical findings that support your suggestion. 

The condition that Maria is suffering from is Myocardial Infarction. Acute myocardial infarction is classified into two types: non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI) (STEMI). NSTEMI is identical to unstable angina. Cardiovascular indicators, on the other hand, are not raised. An ECG shows that Maria has an ST elevation, which means that she is having STEMI. Because of a shortage of oxygen, a MI causes irreparable injury to the muscles of the heart. An MI can affect diastolic and systolic function and leave the patient susceptible to arrhythmias. The other clinical finding is that she has high levels of cardiac-specific troponin in her blood. Troponin is a form of protein present in the muscles of the heart. Troponin is a protein that is not ordinarily present in the blood. Troponin is released into the circulation when cardiac muscles are injured. As cardiac injury worsens, more troponin is discharged into the bloodstream. Elevated troponin levels in the blood may indicate that a person is experiencing or has recently had a heart attack. A heart attack occurs when the flow of blood to the heart is obstructed. Even a minor elevation in the levels of troponin frequently indicates that the heart muscles have been damaged. Troponin levels that are extremely high indicate a heart attack. Within 6 hours of having a heart attack, the majority of individuals have elevated levels of troponin. Almost everyone who has had a heart attack will have elevated levels after 12 hours. Troponin levels may stay elevated for 1 to 2 weeks following a heart attack. 

Explain the expected benefits of a fibrinolytic drug in the above case study by referring to its pharmacodynamics and pharmacological effects. 

Maria was given heparin intravenously. Heparin is an anticoagulant or blood thinner. It helps in preventing the formation of clots of the blood clots. Heparin is a medication that is used to cure and reduce blood clots produced by specific medical diseases or operations. It is also taken prior to surgery to lessen the likelihood of blood clots. It is administered in cardiology to avoid clots in patients with atrial fibrillation and as an adjuvant antithrombin treatment in patients with myocardial infarctions. Heparin is derived from vertebrate liver, lung, mast cells, and other cells. Heparin is a well-known, widely administered anticoagulant with antithrombotic effects. In vitro and in vivo, heparin suppresses the processes that contribute to blood coagulation and the production of fibrin clots. By repressing Factor Xa and thrombin, little doses of heparin in combination with antithrombin III which is the cofactor of heparin, can reduce thrombosis. Once significant thrombosis has occurred, higher doses of heparin can inhibit subsequent clotting by suppressing thrombin and blocking fibrinogen transformation to fibrin. The side effects of heparin is that it can make a person bleed very easily which can be very threatening to the life. The other side effects include internal bleeding, discoloration of the skin, irregular heartbeats, stomach pain, trouble in breathing, nausea, vomiting, tiredness and so on.

Maria has recovered and in addition to the ACE inhibitor has been placed on a diuretic.

Based on what you learnt about pharmacodynamics in BIOL122and considering the drugs that Maria is currently prescribed in BIOL122, explain why care is needed if Maria is planning on taking aspirin 

Heparin has various side effects and there are certain warnings that Marie needs to focus on from preventing her condition to deteriorate. Heparin increases the risk of internal bleeding. It can also induce abnormal bleeding or scarring, extreme pain in the stomach or back, unusual exhaustion, bleeding from the nose, blood in her urine or stools, spitting up blood, or persistent bleeding.