A 47-year-old overweight male with a history of atherosclerosis, diabetes mellitus type 2, and coronary artery disease (CAD) is found by a neighbor unconscious and not breathing in his front lawn where he appears to have been mowing his lawn. He is rushed to a local emergency room where it is determined that he has suffered a massive inferior myocardial infarction. He is sent to the intensive care unit in critical condition where he is placed on advanced life support equipment, and several days later it is determined that he has minimal brain activity.
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After hearing her husband’s condition, his tearful wife asks you how it is possible her husband’s brain might not function if it was his heart that stopped beating. How would you answer?
As the next of kin, his wife has the right to make husband’s medical decisions when he is unable to. Because the length of time that this patient was in cardiac arrest appears to have been substantial, the patient’s recovery is highly unlikely. The medical staff gently informs the wife that she has to make a decision regarding his health care: she can withdraw care now or choose to do everything to keep him alive, even though he will most likely die. She asks you what you think she should do. With your knowledge of neurophysiology, how would you answer her?
MODEL ANSWER
Organization and Control of Neural Functions
Heart attack or Myocardial Infarction (MI), emerge when the flow of blood to a given section of the heart lessens or stops, thus damaging the affected heart muscle (Norris, & Lalchandani, 2018). The common signs and symptoms of MI are chest discomfort or pain, which may extend to the jaw, backside, neck, shoulder, or arm. The pain occurs typically either in the left or center part of the chest and lasts for several minutes (Bulluck, Yellon & Hausenloy, 2016). MI mostly occurs due to coronary heart disorder. Other risk factors that may trigger MI include, but not limited to, poor diet, high blood pressure, smoking, lack of exercise, obesity/overweight, diabetes, high consumption of alcohol, and high blood cholesterol (Homem, Repic & Knoblich, 2015). During a heart attack, the supply of blood to the…
As discussed above, brain damage associated with MI is mainly caused by limited or lack of blood flow to the brain. This condition can affect the entire brain (global ischemia) or a portion of the brain (focal ischemia). Based on reperfusions, ischemia can be either permanent or transient, but the outcome is determined by basic factors like the degree of reduction in blood flow, glucose levels and brain temperatures. Poor supply of oxygen to the brain can affect more than one part of the brain. Among the most vulnerable brain segments is the temporal lobe that store memories. If the cardiopulmonary resuscitation fails to commence within the first few minutes of a heart attack, global cerebral ischemia kicks in which translates to progressive worsening of the brain damage. Gradually, severe and irreversible brain injury occurs, which reduces the patient’s chances of survival. In the case of the 47-year old male, he is ….
Depending on the preferences of the Next of Kin, a patient who has suffered substantial brain injury may be kept on a life support system for quite some time. However, the lifelong suffering associated with life support begs the question of whether such a decision is in the patient’s best interest. Of course, it is of no use to spend the rest of your life completely dependent on a machine. That being said, it is important to note that the patient’s wife, as the next of kin, has the full rights to make health care decisions on behalf the husband (Kon et al., 2016). My advice ….
References
Bulluck, H., Yellon, D. M., & Hausenloy, D. J. (2016). Reducing Myocardial Infarct Size: Challenges and Future Opportunities. Heart, 102(5), 341-348.
Homem, C. C., Repic, M., & Knoblich, J. A. (2015). Proliferation Control in Neural Stem and Progenitor Cells. Nature Reviews Neuroscience, 16(11), 647.
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement. Critical Care Medicine, 44(1), 188.
Norris, T. L., & Lalchandani, R. (2018). Porth’s Pathophysiology: Concepts of Altered Health States. Lippincott Williams & Wilkins.
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