This discussion post is from NSG (Nursing) 530, Advanced Pathophysiology, week 1:
\”Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home. He was taken to the ER via ambulance. His breathing was labored, pulses rapid and weak, and his skin was cold and clammy. An ECG was done which revealed significant \”Q\” waves in most leads. Troponin level was elevated. Arterial blood was draw with the following results:
Ph 7.22
PCO2 30 mm
Hg pO2 70 mm
Hg O2 sat 88%
HCO3 22 meq/liter
1. Aside from the obvious diagnosis of MI, what is Mr. B\’s acid base status and what caused this disturbance?
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Introduction
Cardiovascular disease is a serious threat to the health of people across the globe. Cardiovascular diseases are a group of disorders of the heart and blood vessels. Heart disease is categorized under cardiovascular diseases (Cao & Wu, 2022). It is referred to various types of heart conditions. A heart attack or myocardial infarction occurs when a part of the heart muscle does not get enough blood. The presented case study is about Mr. B, a 70-year-old man who experienced substernal chest pains radiating down his left arm while at home. sub-sternal chest pains radiating down his left arm while at home. Various tests were on the patient to determine a diagnosis. Based on the case study, this paper discusses, apart from the obvious diagnosis of myocardial infarction, the patient’s acid-base status what could have led to the disturbance.
The obvious diagnosis of the patient is a heart attack. As mentioned earlier, a heart attack happens when blood flow is reduced or blocked to a part of the heart. The blockage of blood flow often occurs as a result of a buildup of cholesterol, fats, and other substances in the heart (Saleh & Ambrose, 2018). Some of the symptoms of a heart attack include chest pain that makes one feel pressure, tightness, or squeezing. The pain or discomfort may spread to the neck. Other symptoms may include fatigue, cold sweat, nausea, and shortness of breath. These are similar symptoms that the patient manifested.
The test results of the patient included Ph7.22, PCO2 30 mm, Hg pO2 70 mm, Hg O2 sat 88%, and HCO3 22 meq/liter. This result shows imbalances in Mr. B’s acid-base status. For example, PCO2 30 mmHg was recorded while the normal range is between 35 to 45 mmHg. Furthermore, Ph7.22 was recorded while the normal range should be between 7.35 and 7.45. A decrease in pH below this range is acidosis, and an increase above this range is alkalosis (Bajwa et al., 2022). Therefore, an acid-base disturbance is seen in the patient’s bloodstream.
Respiratory acidosis is 1 of the 4 basic classifications of blood pH imbalances. Normal human physiological pH is 7.35 to 7.45. A reduction in the pH below the normal range is referred to as acidosis. On the other hand, an increase above the normal range is alkalosis (Bajwa et al., 2022). Acidosis (low blood pH) is common in patients with myocardial infarction and may contribute to dysrhythmias among patients. Acid-base disturbance recorded in the results occurred because the body produced too much acid. Blood often becomes more turbulent when one suffers myocardial infarction leading to blood clot formation (Cao & Wu, 2022). This incident may lead to atherosclerotic plaque that may block coronary arteries, hence, preventing the myocardium from receiving oxygen. Furthermore, anaerobic glycolysis will occur which will lead to the production of lactic acid (Low blood Ph) (Bajwa et al., 2022). In acute myocardial infarction, the combination of a fall in cardiac output and arterial hypoxemia leads to tissue hypoxia, metabolic acidosis, and a fall in plasma bicarbonate due to a rise in lactic acid.
In summary, Heart disease is one of the deadliest diseases in the world. The patient presented in the case study experienced myocardial infarction. Apart from a heart attack, the patient also indicated acid-base disturbance, which is a common occurrence in patients who have experienced myocardial infarction.
References
Bajwa, G. S., Hussain, A., & Javaid, M. M. (2022). How to work up an adult patient with metabolic acidosis. British Journal of Hospital Medicine, 1-11. https://doi.org/10.12968/hmed.2021.0582
Cao, Y. W., & Wu, H. Y. (2022). Maybe Not an Acute Inferior Myocardial Infarction. JAMA Internal Medicine, 182(5), 569-569. https://doi.org/10.1001/jamainternmed.2022.0096
Saleh, M., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7. https://doi.org/10.12688/f1000research.15096.1