Analysis of Heart Disease: Coronary Artery Disease

Introduction

In the essay heart diseases we will have a closer look at such a widespread disease as coronory artery disease. It is one of the most common cardiovascular diseases in the United States. Aside from being common, it has resulted in the deaths of over 360,000 Americans in 2017 alone. The premise of funeral service professionals encountering such a frequent disease as a cause of death would fool surface level observations into believing that the conditions of the remains would not have complications during the embalming process. Although there is usually no external trauma to remains who have died due to coronary artery disease and symptoms are subjective to those diagnosed, there are several complications that could arise for embalmers. In this research summary, I will be briefly discussing etiological and pathological conditions of the disease, symptoms, complications, and the post-mortem conditions that are to be expected by funeral service professionals and embalmers.

Symptoms

Coronary atherosclerosis that results in coronary artery disease limits oxygen - rich blood from reaching the heart. As the heart continues to pump demanding more oxygen, symptoms of angina could occur. Angina is a sharp pain in the chest area that occurs due to lack of blood flow to the heart, characterized as feelings of tightness, discomfort, pressure, and pain as a result of coronary artery disease. As your heart is demanding more oxygen-rich blood, especially during heightened periods of physical activity, dyspnea could occur. Dyspnea, or shortness of breath, occurs due to the heart and body trying to supply and circulate blood throughout the arterial system to match the physical activity and demands of the heart. Left-sided heart failure could occur due to the lack of oxygen-rich blood leaving blood vessels and the left atrium of the heart after traveling through the pulmonary valve.

Further symptoms of coronary artery disease could also include pain or discomfort in arms or shoulders, cold sweats, lightheadedness, and nausea.

Another symptom of coronary artery disease is arrhythmia. Arrhythmia is improper beating of the heart, resulting in the rate and rhythm of your heartbeat. The lack of oxygen distribution in cardiac cells results in depolarization of these cells. Depolarization of the cells result in a shift in how the sinoatrial node contracts in the heart and lead to irregularity in the rate of pulsing and rhythm. More specific to coronary artery disease is a type of arrhythmia called atrial fibrillation. Atrial fibrillation is an irregular heart rhythm mostly characterized by rapidness in heartbeat. As rapid heartbeat continues, blood can clot the upper chambers of the heart - the atria- and diminish blood flow to the brain and result in a stroke.

Pathological Conditions

As a result of coronary artery disease, an individual prior to death may have experienced renal complications. As the kidneys blood supply from the heart travels through the descending aorta into the renal arteries, lack of oxygen-rich blood exiting the aorta after collecting in the left atrium could result in pressure increasing in the renal arteries. Increased hypertension in the renal arteries could lead to kidneys suffering from reduced function in excreting waste and higher sodium retention than normal (Barger, 1959). The kidney functions by controlling bodily fluid balance by filtering your blood received from the renal arteries from the aorta and properly absorbing, redistributing, and excreting waste accumulated from the day. If the function begins to slow and impair through increased pressure on renal arteries, so will the filtration and sodium absorption. As sodium increases, so does water and fluid retention.

As the body’s fluid/water content increases, this adds further strain on the heart to essentially keep up with the increased demand for oxygen to combat this increase in arterial pressure. Retaining fluid as a result could result in people feeling the need to urinate frequently as well. As sodium levels increase, this would eventually cause damage to the endothelium lining of blood vessels. If the arterial walls are already becoming narrowed and are weakening due to increased pressure, increased sodium presence in the vascular system could increase risk for arterial stiffness and damage. Narrowed arterial walls that are damaged by sodium could then become completely blocked and further complicate the condition of the individual.

Thrombosis, the formation of blood clots, occurs very frequently with coronary artery disease. As lack of mobility in arterial walls increases due to atherosclerosis, the risk in experiencing thrombosis resulting in a heart attack also increases. Thrombosis is intravascular. If pressure already increases due to the narrowing of arterial walls, this could limit distribution of blood (or perhaps, embalming fluid?) throughout the body. Thrombosis is created through the disruption of vessel anatomy, either through surgery, injury, limited physical movement, or even certain medications.

Embalming Complications

To funeral service professionals and embalmers, a decedent that had suffered coronary artery disease is expected to undergo complications in the embalming process. As the circulatory system had experienced a variety of issues that resulted in damage during life, this would not disqualify the distribution of embalming fluid also experiencing similar circulatory disruptions. Surfactants meant to decrease surface tension in embalming fluids would be helpful in even distribution, however there are some issues that are left due to increased fluid tension, pressure on the circulatory system, and thrombus / embolus presence.

As increased fluid retention occurs in the body, so does the possibility of developing anasarca. As generalized edema occurs throughout the body, this could result in a higher index in your embalming solution to dehydrate as much excess fluid that was accumulated throughout the body. In regards to the condition of the remains if excess fluid still remains after the embalming process, this could lead to problems in dressing and casketing the decedent due to the possibility of soiling their clothing and casket. Edema could result in so much moisture being retained that the epidermis peels. Descuamation on the body extremities could result in the utilization of unionalls to prevent soiling and odor escaping.

Another complication that could occur in the embalming process is the damage already in the circulatory system due to the presence of thrombus lodged in vessel walls. As thrombus gets dislodged, it will become emboli, which are debris moving through arterial walls until they once again clot another vessel. This could hinder proper distribution of the embalming fluids. As thrombi/emboli become lodged in vessels, this could increase pressure in vessels and even result in swelling and burst vessels. Damaged leaking vessels release embalming fluids as extravascular, which unfortunately cannot be removed once the embalming process is complete. This would result in obvious disfigurement of the affected area, which if there were stubborn thrombi present in the common carotid, could result in swelling of the neck and head/ facial area on the viewing side.

A third complication to the embalming process would be if the decedent had suffered left-side heart failure. Accumulation of blood in the left atrium and pulmonary valve could result in pulmonary edema in the decedent. Pulmonary edema after post-mortem movement of the remains could lead to purging of the lungs.  

Conclusion

Coronary Artery Disease is the result of plaque forming in artery walls due to cholesterol buildup. As the plaque accumulates, arteries become narrow and hinder proper adequate blood flow to the heart. Arterial walls narrowing could increase blood pressure flow and result in hypertension. Oxygen - rich blood fails to be properly supplied to the heart, resulting in a series of subjective issues for those affected that are exacerbated with physical activity. Increased plaque build-up in arterial walls, called atherosclerosis, could result in damage to the arteries that necessitate for blood clots to occur and completely block blood-flow, resulting in a myocardial infarction that could result in death. Lack of oxygen-rich blood entering the heart could also result in heart failure.