# 1. Explain the term ‘heart attack’ (a myocardial infarction)? 2. Explain why Naomi has shortness of...

###### Question:

1. Explain the term ‘heart attack’ (a myocardial infarction)?
2. Explain why Naomi has shortness of breath?

An Elderly Woman Who Suddenly Develops Severe Shortness of Breath A Near Death Experience

Compartmentalization of body water is achieved by striking a balance between intravascular hydrostatic pressure and oncotic pressure. The difference between these two forces is a calculation known as the net filtration pressure (NFP). Changes in either hydrostatic or oncotic pressure can lead to disastrous shifts in body water.

Naomi is a 78-year-old former school teacher who lives with her husband in a retirement center. Never a smoker and cautious with her diet, she has always considered herself to be in good health, at least for her age. That is until recently.

For the past few months, Naomi has gotten short of breath just walking to get the mail plus she’s had problems with ankle swelling. But, things got much worse a week ago. One night she jolted awake at 2:00 AM, gasping for breath and gurgling as if she were drowning. She was convinced she was dying. In fact, she was. Naomi’s husband called 911 and the ambulance attendants administered oxygen on the way to the hospital. Naomi’s condition had improved a little by the time she arrived in the ER, but she was still short of breath with audible gurgling as she struggled to breathe. Her ankles were swollen, and if one pressed a finger against her skin, a divot would remain. Naomi was in heart failure. Naomi was not experiencing a ‘heart attack’, a myocardial infarction, which is anoxic (absence of oxygen) death of a portion of the myocardium due to sudden and complete occlusion of a coronary artery. Rather the muscle of her entire left ventricle was weak and only feebly beating. Naomi does have atherosclerosis in her coronary arteries, which causes serious reduction in blood flow to the heart muscle, but there was no complete blockage. The reduced coronary blood flow meant her myocardium was not being adequately oxygenated and therefore could only work at about half of its strength.

• A weak left ventricle means only about 50% of the blood in the ventricle is pumped out with each contraction cycle (normally it’s 70% or more). • Since the blood is slowed down going through the left ventricular chamber, there is backup of blood in the left atrium and the pulmonary vasculature. (It’s like a traffic jam behind an accident.) • The backup of blood creates an increase in the hydrostatic pressure within the pulmonary capillaries, and eventually the entire venous system.

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