Maria Case Study
Maria is a sedentary, 68-year-old woman who is overweight. She complains that her hands and feet
are always cold and she tires quickly when cleaning the house. Maria comes in for a visit. When she
comes in for a visit, her blood pressure is one-eighty-four over ninety-eight. She has edema around
her ankles and legs. You are concerned about an echocardiogram that indicates Maria has an
enlarged heart.
Student Name: Najah Musa
1. Identify two reasons why Maria will have tissue ischemia. How might this lead to hypoxia?
Tissue ischemia is defined as a lack of blood in a tissue due to constriction or obstruction of
blood vessels, which means that oxygen is not being supplied enough to the tissue because of plaque
build-up. On a cellular level, the myocardial cell injury causes a decrease in blood supply resulting from
the affected cells becoming dependent on anaerobic glycolysis for their ATP (Abdellatif, 2012). In
Maria’s case, being overweight and having hypertension narrows her arteries which means that her body
isn’t getting sufficient blood to the rest of her body.
Having cold hands indicates that she is not getting enough oxygen to her tissues. When we
perform a capillary refill assessment of the nails, we expect to find more than 3 seconds because there
isn’t sufficient oxygen pumping to her body given to her enlarged heart. Also, another indication of an
enlarged heart that results in tissue ischemia is edema. Maria has hypertension and is overweight, there
could be a build-up of fat in her arteries which may lead to her body’s inability to pump blood to the rest
of her body, which leads to hypoxia.
2. What are the two early and reversible changes that occur to tissue cells when they are hypoxic?
The two early and reversible changes that occur on tissue cells when they are hypoxic are an
increase in sodium on the inside of the cell, which is indicative of swelling (which is the failure of Na+\
K+ pump) and anaerobic metabolism. This means that there is absence of oxygen which can result in the
production of lactic acid. Usually, in anaerobic metabolism, there is a lower number of normal oxygen
material and pressure in the cell and not sufficient oxygen cellular oxygen delivery to maintain
homeostasis. These changes will impact the conduction of impulses in the cell, which as a result affects
sodium and potassium channels in producing an action potential. It limits the movement and contraction
of muscles affected. Both can be reversed with an adequate supply of oxygen (Zima, 2006).
3. What specific type of cellular adaptation has taken place in Maria’s enlarged heart? What made
you come to this conclusion?
With an enlarged heart, the heart tends to dilate because of increase in cell size (volume stress),
enhanced protein synthesis, and heightened organization of sarcomere (Zima,2006). As a result of this,
more pressure is placed on the heart making it larger. This cellular adaptation indicates hypertrophy.
Hypertrophy is when there is increased growth of muscle cell size because of the heart enlargement,
which results in stress on the heart. Given that she has those present symptoms such as tiredness, cold
hands, and high blood pressure which is a major concern for any heart problems, it indicates that her
tissues are deprived of oxygen.
References
Abdellatif M. Differential expression of microRNAs in different disease states. Circ. Res. 2012;110:638–
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Zima AV, Blatter LA. Redox regulation of cardiac calcium channels and transporters. Cardiovasc Res.
2006;71(2):310–21. [PubMed] [Google Scholar]
