Question

Please answer a - d

4a. Does metabolism of myocardial muscle cells change after infarction? If so, how? (2 points) 4b. Are nitrates commonly used for myocardial infarction, why? (2 points) 4c. Compare and contrast osteoarthritis and rheumatoid arthritis (5 points) 4d. Why is gout called a rich man's disease? What metabolite and which enzyme are responsible for generation of gout? Where and why does this metabolite accumulate? (5 points)

Answer 1

Question 1.

Severe metabolic changes begin within few seconds after coronary occlusion. And the severity depends upon reversal of the occlusion and restoration of blood flow either by Percutaneous intervention or by Thrombolysis. The high-energy phosphates are hydrolyzed, intracellular pH lowers as a consequence of the activation of anaerobic glycolysis, and extracellular potassium levels increase leading to higher risk of arrhythmias and cardiac arrest.

Question 2

Nitrates is used as the first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin release nitric oxide, which causes vasodilation and increases blood flow to the myocardium.Study shows significant reduction in mortality among nitrate-treated patients. Patients who developed left ventricular failure after acute myocardial infarction benefitted the most from nitrate therapy. The best route of nitroglycerin administration is intravenous infusion. The dose is initially 5 micrograms/min and is increased according to the blood pressure.

Question 3.

Component	osteoarthritis	rheumatoid arthritis
Cause	mechanical wear and tear	autoimmune disease
Age	later in life	begin at any time in life
Speedof onset	slow	rapid
Pattern of joint affected	large weight bearing joints	all joints and symmetrically affected
Joint symptom	joint ache Little or no swelling	joint ache, swelling and stiffness
Morning stiffness	lasts less than an hour and stiffness returns at the end of the day.	lasts more than an hour.

Treatment of osteoarthritis include pain killers, physiotherapy and joint replacement surgeries

Treatment of rheumatoid arthritis include disease modifying antirheumatoid drugs.

Question 4. GOUT is called asthe rich mans disease because foods such as wine, red meat and other rich foods contribute to increased uric acid levels.

The metabolite is uric acid. And the enzyme deficiency in purine synthesis cause gout. Joints are common sites of deposition because of lower body temperature and decreased monosodium urate solubility.