Lecture 6: Cardiovascular SystemCase 1
A 55-year-old retired man complained of a severe, crushing sensation with pain radiating to the left
shoulder, triggered by a soccer match with his grandchildren. The chest discomfort brought by exertion
was relieved by rest. Emergency room examination resulted in the following information:
Heart Rate (HR)
Stroke Volume (SV)
Blood Pressure (BP)
98 b/min
58 ml/beat
160/110 mm Hg
ECG Record image:
Patient Result
The following day an exercise tolerance test was performed to test the functional response to graded
stress. The ECG response during exercise was characterized by a downward sloping (depression) ST
segment. Mid exertion resulted in chest pain, which was relieved by sublingual nitroglycerin.
The Angiography showed luminal obstruction (blockage/narrowing) in three major coronary arteries.
a. What is the term used for the chest pain experienced by the patient in this case?
b. What is the cause of this pain?
c. Compare the ECG reading for the patient to a normal ECG reading?
(Describe the differences in terms of the waves, segments, and intervals).
d. What does ST segment represent in terms of Action potential?
e. What is the action mechanism of the sublingual nitroglycerin in this case?
Human Physiology PHYL201 Spring 2022-23
Lecture 6: Cardiovascular System
Case 2
During a physical examination, a 64-year-old female who weighed 110 Kg, had a blood pressure of
180/115 mm Hg on three sequential days. Further examination showed low plasma renin activity,
elevated total peripheral resistance (TPR), and cardiac output (CO) of 7.2 L/min. Recommended therapy
plan included weight reduction to her ideal level, low-salt diet, and exercise.
a. Explain how the body physiologically controls blood pressure and maintain homeostasis?
b. Calculate the patient’s mean arterial blood pressure and pulse pressure?
c. What is the possible diagnosis for this patient?
Human Physiology PHYL201 Spring 2022-23
Lecture 6: Cardiovascular System
Case 3
A 60-year-old female presented at the emergency department with acute onset shortness of breath.
Symptoms began approximately two days before and had progressively worsened. She does report
swelling in her bilateral lower extremities. Subsequently, she could not leave her bed for several days
except to use the restroom due to feeling weak, fatigued and shortness of breath.
Past medical history: coronary artery disease, myocardial infarction, hypertension, diabetes mellitus and
obesity.
Physical examination:
Heart rate (HR) = 74 bpm
Blood pressure (BP) = 104/66
Diagnosis: acute heart failure
a. Using a flow chart, explain the physiological (normal) direction of blood flow in the heart?
b. Predict what is happening to this patient (Explain the pathophysiological reasons of having
shortness of breath and bilateral lower extremities edema)?
Human Physiology PHYL201 Spring 2022-23
Lecture 6: Cardiovascular System
Case 4
A 49-year-old schoolteacher was a smoker with a history of diabetes mellitus, hyperlipidemia, and
obesity. He was awakened from his sleep at 2:47 am with crushing chest pain which radiated to his left
shoulder, arm, back, neck and jaw. He was transported to the nearest hospital after receiving the
appropriate medical interventions.
Upon the arrival to the emergency department at the hospital, the patient’s Electrocardiogram (ECG)
showed ST-segment elevation. He was started on heparin (anticoagulant drug) and emergency
catheterization (Angiogram) showed a right coronary artery which was totally occluded (blocked).
Angioplasty was attempted but failed to reopen the right coronary artery. Subsequently, the patient has no
response for the given treatment, and he was given comfort measures and he died peacefully.
Patient ECG Reading
a. What is the diagnosis for this case? What was the reason for having this diagnosis? What are the
possible outcomes of this diagnosis?
b. Define Angiography and Angioplasty?
c. Compare the ECG reading for the patient to a normal ECG reading? (Describe the differences in
terms of the waves, segments, and intervals).
Human Physiology PHYL201 Spring 2022-23
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