Pathophysiology of Disease: High BP and NIDDM

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Table of Contents

Relationship of Smoking, Diabetes, and High Blood Pressure to his Death
Most Probable Cause of Death
Heart Attack and No Signs of Myocardial Infarction
Other possible risk factors
References

A 62-year-old male was reported to have severe chest pain, which was described as a squeezing feeling in his chest area. He passed away in this instance, but the autopsy undertaken showed no myocardial infarction. His past history showed records of high blood pressure, Non-Insulin Dependent Diabetes Mellitus which he controlled through his diet, and a habit of smoking 60 cigarettes daily, for a span of thirty years. We will look into the cause of his death, and the relationships of his body incapacities to the grounds of his demise.

Symptoms of myocardial infarction are chest pain due to injured heart muscles and chest pressure sensation. When blood flow is blocked and is not restored, heart muscles die and death heart muscle is irreversible. The squeezing chest pain around the chest can be due to myocardial infarction or high BP. The patient was suffering from High Blood pressure and non-insulin dependant diabetes mellitus (NIDDM). These symptoms can also appear with High BP and NIDDM.

The probable cause of death was high blood press and NIDDM. Various research studies have confirmed that increased numbers of deaths are reported due to non-insulin dependant diabetes mellitus. NIDDM is high-risk factor in mortality due to cardiovascular disease. Age factor, coronary artery disease, and arterial hypertension are independent risk factors in mortality due to cardiovascular diseases.

There are several causes of hypertension and occurs when the force of blood against walls increases above normal. Consistent high BP is a high-risk factor for heart attack and stroke. The main causes are stress, smoking, lack of physical activity, poor diet, and obesity.

Myocardial infarction is a sudden heart attack due to the death of heart muscles because of sudden blockage of blood supply to muscles of the heart. However, an autopsy revealed no evidence of myocardial infarction hence this is ruled out. High cholesterol levels and blockage of arteries were not the problems in this case.

Relationship of Smoking, Diabetes, and High Blood Pressure to his Death

Smoking has always been found to be a leading cause of death, due to the side effects it leaves on the body. Apart from damaging the lungs, it is a major root of pulmonary cancer. Cigarette smoking has been found to be an important factor contributing to carcinoma of the lungs (Doll, 2000).

Diabetes is a disease in which the body experiences very high levels of glucose, causing excessive urination, and giving rise to metabolic disorders. Non-Insulin Dependent Diabetes Mellitus, or Type II diabetes, has been found to be linked with hypertension, or high blood pressure. The blood pressure of humans may be measured as either high or low, according to a standard set of measurements, which is considered normal. This normal measurement is 120/80, where 120 is the systolic blood pressure and 80 is the diastolic reading. Systolic blood pressure measurements on an elevated level indicate that the patient is suffering from ‘high’ blood pressure, because the rate, at which the pressure is exerted on the walls of blood vessels during each heartbeat, is raised.

Systole is the condition in which during a single beat of the heart, the ventricles contract and force blood into the arteries. It is the highest arterial pressure that occurs in a cardiac cycle. Diastole is the lowest pressure, which occurs when the heart muscles relax and the ventricles are filled with blood. Mortality rates of individuals with high systolic blood pressure have been found to be greater, than those patients possessing higher diastolic blood pressure (Ungar, et.al. 2009).

The patient under consideration has not been found diagnosed with albuminuria, but it can be assessed that he may be suffering from such a condition, due to diabetes and high blood pressure. Renal diseases do occur as a result of arterial blood pressure (Viberti, 1988). He may either have microalbuminuria, or albuminuria, which is a common disorder in diabetic patients. It is not found prevalent in patients during the first five years of diabetes, however, it may be determined after a number of years, and if urinary protein excretion is greater than 0.5g in 24 hours, renal failure may occur, along with premature cardiovascular mortality. Albuminuria has also been found to mediate the interlink of high blood pressure and cardiovascular mortality (Palmas, et.al, 2009).

Long-term arterial pressure, or arterial hypertension, is associated with cardiovascular disease (Niang, 2008). Even though the patient was not found to have a myocardial infarction, there still persists some association of his death with heart dysfunction, because diabetes, high blood pressure, and his smoking habits, all link to cardiac malfunctioning eventually. Diabetes alone also may result in increased all-cause mortality suggest some studies (Zoppini, et.al, 2008).

It is apparent that the patient did not show any signs of cardiac failure, but diabetes and high blood pressure persistent in the body may have led to such a cause, which may not have been diagnosed efficiently. The body is negatively affected by the prevalence of any such disease, giving rise to other deformities or abnormalities in the normal functioning processes.

Systolic blood pressure has been found to be linked more to heart failures or kidney diseases, as compared to diastolic blood pressure (Lim, 2007). Some studies have also shown that a variation in the blood pressures of individuals may also cause deaths; due to a rise in cardiovascular events (Brotman, et.al, 2008).

Heart failure may have occurred in this patient due to a non-dipping effect of blood pressure. Normal individuals have a dipping effect of blood pressure, which drops at night and rises during the day. If this pattern is disturbed in any way, the body gets affected; the bodily vital organs suffer, including the brain, heart, and kidneys.

Most Probable Cause of Death

The most probable cause of this individual’s death may be cardiac arrest due to hypertension and diabetes. He showed no signs of myocardial infarction, which means that the blood flow to his heart was normal. A sudden death like this one with no previous signs of heart disorders may mean that a sudden cardiac arrest occurred, in which the electrical system related to the heart becomes irregular, such a condition is termed arrhythmia. On the contrary, a heart attack occurs when the blood flow to the heart is interfered with by arterial blocking, which leads to atherosclerosis.

The patient’s habit of smoking had risen his vulnerability to sudden cardiac arrest. Continued smoking has shown leading to an ongoing atherosclerosis process. However, since a diurnal blood pressure has also been seen to increase the risks of heart failure (Shin, et.al, 2007), we can assume that the deceased may have had a dipping blood pressure at night, which was probably never checked for.

Smoking causes heart failure, and regular or chain smokers need to quit their habit for normal functioning of the body. The puffing of smoke increases blood pressure and heart rate. Smoking also causes stickiness in those vessels that feed the heart, which indirectly cause a great damage to the general functions of this organ. Lesser supplies of oxygen are carried to the rest of the body parts after entering the heart.

Heart Attack and No Signs of Myocardial Infarction

Heart attacks may occur due to spasms in the coronary arteries. The reason for such spasms is unknown, but they may cause a hindrance in the normal blood flow to the heart because of the narrowing of arteries.

A heart attack may cause sudden cardiac arrest. This patient may apparently be suffering from a condition known as restrictive cardiomyopathy. Cardiomyopathy is a condition in which the heart muscle becomes inflamed and fails to function normally. One of the causes of cardiomyopathy is elevated blood pressure. Among the three types of cardiomyopathic conditions, this patient may have experienced ‘restrictive cardiomyopathy’, because in this condition, the walls of the heart become rigid, and it becomes more difficult for the blood to fill into the ventricles. The reason why this is suggested for this patient, is, that he complained of intermittent claudicating. This claudication may have been due to the restrictive cardiomyopathy, which apart from affecting the heart muscle, also contributes to swollen hands and feet, and regular feeling of tiredness.

Thus it is not necessary that heart attack means specifically myocardial infarction. The arteries may block with time due to plaque build-up. Many causes lead to heart failure, and in the case of this patient, it may be due to the formation of plaque in the arteries due to excessive smoking, and hypertension prevalence in the body because high systolic blood pressure has also been found to raise risks of heart failure.

Other possible risk factors

Lungs are a vital part of the human body. They are the suppliers of oxygen, which is very essential for the proper functioning of the body. Our brain constantly needs oxygen. Lungs actually absorb oxygen from the incoming air and put out carbon dioxide. Improper lungs would result in the death of the individual.

Lungs receive directly the smoke inhaled, and when it is exhaled some smoke remains inside the lungs. The smoke of a cigarette contains more than 4000 chemical compounds. 69 of these chemical compounds are notorious for causing cancer. Another fact why lungs will further increase the chances of getting affected by the smoke is that lungs are damped or have moist. The damped inner surface catches the smoke, thus helping the chemicals to accumulate on the interiors of the lungs. The accumulation forms gradually into a layer, this layer blocks the lung’s porous surface. This blockage deters air to enter the inner lungs’ surface, and so less and less oxygen is processed.

Lung cancer is the most dangerous gift a cigarette has for a smoker. Almost 90% of lung cancer is directly related to the lungs. The problem with lung cancer is that it is usually discovered when it has already spread. After which the treatment becomes very difficult. Smoking causes the lung’s cleaning mechanism to destroy. The lung’s cleaning system contains hair-like structures called cilia which help trap particles with the help of mucus. But the cigarette smoke destroys the mucus and thus the lungs can no longer keep themselves away from dangerous particles which are present in the smoke of the cigarette. The prolonged presence of these substances in the lungs is an invitation to lung cancer. The particles after some time get a chance to penetrate the cells resulting in lung cancer.

Cigarette smoke literally eats away the lungs. Neutrophils a chemical substance is associated with the destruction of lungs tissues. A study analyzed Neutrophil’s concentration smoker’s lung and found that the cigarette actually helps in the destruction of the lung tissues.

Cigarette smoking is the major factor “responsible for chronic obstructive lung disease, a deadly disease responsible for more than 100,000 deaths in the US each year, making it the fourth most dangerous disease.” (COLD) Smoking causes physical changes in the passageways of the air in the lungs that cause hindrance and damage airflow. The walls of the alveoli become swollen and damaged. Over time they lose their stretch and areas of dead air (called bullae) are formed in the wounded areas. This gives rise to what is known as chronic obstructive lung disease (COLD).

Nicotine is the main reason why people become addicted to cigarettes. Nicotine is a well-known addiction chemical compound. The process of addiction although is still not 100% clear, but some new research has shown that nicotine acts on a novel nicotinic receptor complex, that is strategically located at the sites of communication between neurons in the brain. This relationship of nicotine is reported to cause the short-term relaxation and easy feeling that smokers feel.

Smoking is reported and verified to be dangerous for the brain too just like it is for any other part of the body. At first, the brains metabolic activity is altered by nicotine. The activity is boosted by cigarettes. We know that when the natural rate of anything in the body is disturbed it is not a good sign. Hence cigarettes are harming the nerve cells and hence the brain cells.

The nicotine specifically targets the neurons- the building blocks of the nervous system. The nicotine is thus detrimental during the brain development process. In research the data clearly showed that prenatal exposure to nicotine can be harmful.

Smoking has been investigated in neural tube defects. The central nervous system, which includes the spinal cord and the brain, in the developing embryo, is known as a neural tube. Normally the neural tube closes completely. If, however, all or part of the neural tube fails to close, the baby has a neural tube defect. Smoking has been found to add to the chances of neural tube defects. Hence smoker parents are at greater risk of having an NTD baby.

In a study Nicotine in found to be responsible for destroying brain cells. An experiment with RAT brain showed that structural changes were stimulated by the presence of even very small concentrations of nicotine. The experiment was conducted on developing brains, which means that babies are at potential risk who are in womb of a smoker mother.

Although cigarettes have not yet been verified to be associated with brain cancer but some research is suggesting a link. Several studies have implicated dietary intake of N-nitroso compounds as a risk factor for brain tumors. And tobacco or cigarettes are sources of many n-nitroso compounds, which may reveal a link between brain cancer and cigarettes. Another evidence of brain cancer association with cigarette comes from the fact that exposure to vinyl chloride is an environmental risk factor for brain cancer. Vinyl chloride is a carcinogen, that is, a cancer-causing substance. It is present in tobacco smoke.

Dangerous chemical compound exposure is a reason for brain cancer. Many industries have been declared to be a potentially higher risk for their employers as they work with carcinogen compounds. Among the many industries, tobacco industry is also declared to be at higher risks of developing brain cancer in their workers.

References

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Lim S. Recent update in the management of hypertension. Acta Med Indones. 2007; 39(4):186-91.
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Niang A. Arterial hypertension and the kidney Dakar Med. 2008;53(1):1-6.
Palmas W, Pickering TG, Teresi J, Schwartz JE, Moran A, Weinstock RS, Shea S. Ambulatory blood pressure monitoring and all-cause mortality in elderly people with diabetes mellitus. Hypertension. 2009; 53(2):110-1.
Shin J, Kline S, Moore M, Gong Y, Bhanderi V, Schmalfuss CM, Johnson JA, Schofield RS. Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure. J Card Fail. 2007; 13(8):656-62.
Ungar A, Pepe G, Lambertucci L, Fedeli A, Monami M, Mannucci E, Gabbani L, Masotti G, Marchionni N, Di Bari M. Low diastolic ambulatory blood pressure is associated with greater all-cause mortality in older patients with hypertension. J Am Geriatr Soc. 2009;57(2):291-6.
Viberti, G. Etiology and prognostic significance of albuminuria in diabetes Diabetes Care, Vol 11, Issue 10 840-845 1988. Web.

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