Case Study 1: Cellular Adaptation, Injury, and Death

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. At her most recent visit to her doctor, her blood pressure was 184/98 mm Hg. She has edema around her ankles and legs, and her physician is concerned about an echocardiogram that indicates Maria has an enlarged heart.

Identify two reasons why Maria will have tissue ischemia. How might this lead to hypoxia?
What are the two early and reversible changes that occur to tissue cells when they are hypoxic?
What specific type of cellular adaptation has taken place in Maria’s enlarged heart? What made you come to this conclusion?

Two Reasons why Maria will have Tissue Ischemia and how this might lead to Hypoxia

Ischemia is characterized by impaired excretion of the products of metabolism, such as sweat and lactic acid, and impaired oxygen delivery to vital organs. Impaired removal of the end products of metabolism can lead to necrosis, which, in turn, affects the cellular functioning of the lungs, causing hypoxia (Veit, Pak, Brandes, & Weissmann, 2015). Besides, ischemia also reduces blood supply because of vasoconstriction due to vascular obstruction, decreasing the blood and oxygen supply to the lungs and the heart. Moreover, cardiac ischemia is caused by the vasoconstriction of the muscles lining the muscles due to a limited amount of oxygen or the accumulation of calcium in the arteries, which may contribute to hypertension (KG Altalhi, 2019). The blood-related complications could be caused by the response mechanisms from homeostasis to maintain or regulate a constant internal environment when agitations are changed in the negative deflection. The inflammation and edema around Maria’s legs and ankles could be due to the constriction of blood to tissues leading to inadequate glucose and oxygen supply to metabolic sites in the body.

The two events above can lead to hypoxia due to the limited amount of blood and oxygen supplied to different organs. Therefore, if Maria continues to suffer from these two events, her body organs will start to register a significant oxygen deficit, which leads to hypoxia. According to Viscor et al. (2018), hypoxemia is characterized by low amounts of oxygen in the blood, which causes hypoxia. On the other hand, hypoxia is a state of having a lower-than-normal amount of oxygen in tissues due to the failure of the blood to carry the normal amount of oxygen to the tissues to meet the demands of the body.

The Two Early and Reversible Changes that Take Place in Hypoxic Tissue Cells

The two first and rescindable changes evident in tissue cells when they are hypoxic include a decrease in the ATP and acute cellular swelling. Acute cellular swelling is caused by the retention and accumulation of sodium ions in the cells. Viscor et al. (2018) note that hypoxia or deprivation of oxygen hampers metabolic and aerobic oxidation leading to cell injury and subsequent apoptosis. Therefore, it is imperative to study the biological aspects that influence cell and body tissue changes during cell damage. Two critical morphologies correlate to reversible cell damage: fatty change and swelling of cells.

The swelling of cells is caused by the failure of ion pumps, which depend on the energy supplied by the plasma membrane. This makes the pumps unable to maintain fluid and ionic homeostasis. On the other hand, changes in fats lead to numerous forms of toxic metabolic, and hypoxic injuries, manifested by the presence of large or small lipid vacuoles in the cytoplasm (Viscor et al., 2018). The impact transpires in the cells that participate and are involved in fat metabolism such as myocardial and hepatocyte cells.

The Specific Type of Cellular Adaptation that has Occurred in the Enlarged Heart of Maria

Hypertrophy is the specific cellular adaptation that has occurred in Maria’s enlarged heart. Adaptations are temporary changes that occur in phenotype, size, number, metabolism, and cellular function in response to the changes in the surrounding environment. The hypertrophy in Maria’s enlarged heart happens when hyperplasia in the heart because the cardiac muscle fibers fail to divide mitotically (Habecker et al., 2016). In cell biology and cell pathophysiology, cellular adaptations refer to the cells’ changes in response to the adverse impacts caused by the subsequent changes in the environment (Viscor et al., 2018). The adaptations may either be physiological, which means normal adjustments, or pathological meaning abnormal adjustments.

Viscor et al. (2018) suggest five types of adaptations, including dysplasia, atrophy, hyperplasia, metaplasia, and hypertrophy. In this case, Maria is suffering from the latter pathology. Maria’s heart and kidney have augmented the risk of overgrowth characterized by a rise in intracellular proteins instead of intracellular fluids. Some patients with heart inflammation may not experience any symptoms; hence, they may not notice it. On the contrary, other patients may experience different symptoms, including abnormal heartbeat, shortness of breath, and edema, or swelling of blood vessels (Veit, Pak, Brandes & Weissmann, 2015). These include the symptoms that Maria has been diagnosed with; therefore, among others, the symptoms are the reason that leads to the conclusion that Maria is suffering from adaptive pathologic hypertrophy. Besides, adaptive pathologic hypertrophy can also be catalyzed by conditions that trigger the heart to increase the heartbeat making it pump harder than normal. In effect, this damages the cardiac muscles, and Maria’s condition is characterized by high blood pressure, which might contribute to adaptive pathologic hypertrophy.