Case Study 2

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 two early and reversible changes 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?

Predict why Maria’s heart has become enlarged. Why doesn’t this enlargement give her the same cardiac strength and endurance as a well-trained athlete?