What electrocardiogram (ECG) change would the healthcare professional assess for when a patient's myocardial infarction through the myocardium from the endocardium to the epicardium?

A. Atherosclerosis causes ischemia of the intima: While atherosclerosis can affect the intima (the inner layer of the blood vessel), it primarily leads to plaque formation and vessel wall changes rather than causing ischemia directly in the intima. Ischemia typically refers to reduced blood supply to tissues.

B. Atherosclerosis erodes the vessel wall: Atherosclerosis leads to the formation of plaques that can erode and weaken the vessel wall over time. This weakening can create areas of localized dilation, leading to the development of aneurysms. The disruption of the structural integrity of the vessel wall due to atherosclerosis is a key factor in the formation of aneurysms.

C. It increases nitric oxide: Atherosclerosis is associated with impaired endothelial function, which typically results in reduced production of nitric oxide rather than an increase. Nitric oxide is a vasodilator that helps maintain vascular health, and its decrease contributes to vascular dysfunction.

D. It obstructs the vessel: While atherosclerosis can lead to vascular obstruction through plaque buildup, the direct relationship between atherosclerosis and aneurysm formation is more about the weakening and erosion of the vessel wall rather than simply obstructing it. Obstruction can lead to ischemia, but it is not the primary mechanism leading to aneurysm development.

A. Left heart failure: COPD primarily affects the lungs and increases pulmonary vascular resistance, leading to right-sided heart strain rather than left heart failure. Left heart failure is more commonly associated with conditions such as hypertension, myocardial infarction, and valvular diseases, which impair the heart’s ability to pump blood systemically.

B. Restrictive cardiomyopathy: Restrictive cardiomyopathy is a condition where the heart muscle becomes stiff and loses its ability to relax and fill properly, often due to infiltrative diseases such as amyloidosis or sarcoidosis. COPD does not directly lead to restrictive cardiomyopathy, as its primary cardiovascular complication is increased pulmonary resistance causing right heart strain.

C. Hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy is characterized by abnormal thickening of the heart muscle, usually due to genetic mutations. It primarily affects the left ventricle and impairs diastolic filling. COPD does not cause hypertrophic cardiomyopathy, as its cardiovascular effects are due to pulmonary hypertension and right ventricular overload rather than structural abnormalities of the myocardium.

D. Right heart failure: Chronic COPD leads to persistent pulmonary hypertension due to hypoxic vasoconstriction and remodeling of pulmonary vessels. This increased pulmonary vascular resistance forces the right ventricle to work harder to pump blood into the lungs, leading to right ventricular hypertrophy and eventual right heart failure, also known as cor pulmonale. Symptoms include peripheral edema, jugular vein distention, and hepatomegaly due to systemic venous congestion.