Which cellular adaptation would occur in a client who has enlargement of the cells in the heart due to heart failure?

Choice A reason: Cortisol, a stress hormone, suppresses immune and inflammatory responses, slowing fibroblast activity and collagen synthesis, which impairs wound healing. This anti-inflammatory effect prioritizes energy allocation to stress response over tissue repair, making decreased wound healing a correct effect of cortisol during stress.

Choice B reason: Cortisol stimulates gastric acid secretion by enhancing gastrin release and reducing mucosal protection, increasing the risk of ulcers. This effect supports energy mobilization during stress by promoting digestion but can lead to gastrointestinal complications, making increased gastric acid secretion a correct effect.

Choice C reason: Cortisol promotes gluconeogenesis and glycogenolysis in the liver, elevating blood glucose levels to provide energy for the stress response. It also induces insulin resistance, ensuring glucose availability for critical tissues like the brain, making increased blood glucose a correct effect of cortisol.

Choice D reason: Cortisol suppresses the immune response by inhibiting cytokine production and lymphocyte proliferation, reducing inflammation and immune activity. This does not align with increased immune response, as cortisol’s immunosuppressive effects are well-documented, making this choice incorrect for the stress response.

Choice E reason: Cortisol increases blood pressure via mineralocorticoid effects, enhancing sodium retention and vascular tone. This supports cardiovascular stability during stress, not decreased blood pressure, which would be counterproductive in a fight-or-flight response, making this choice incorrect for cortisol’s effects.

Choice A reason: Coronary artery vasospasm causes transient vessel constriction, reducing blood flow to the myocardium, leading to ischemia and potentially infarction. This is a recognized cause, particularly in variant angina, making this a correct mechanism for myocardial infarction.

Choice B reason: A thrombus forming in a coronary artery, often due to plaque rupture, obstructs blood flow, causing myocardial ischemia and infarction. This is the most common cause of myocardial infarction, making this a correct mechanism.

Choice C reason: Chest wall bruising from trauma does not directly cause myocardial infarction, which requires coronary artery occlusion. Trauma may cause cardiac contusion but not infarction, making this choice incorrect for myocardial infarction development.

Choice D reason: An embolus, such as from a clot elsewhere, can block a coronary artery, stopping blood flow to the myocardium, causing infarction. Though less common than thrombosis, it is a valid mechanism, making this a correct choice.

Choice E reason: Systemic infection with hyperthermia does not directly cause myocardial infarction. It may increase cardiac demand, potentially exacerbating ischemia, but infarction requires coronary occlusion, not just fever, making this choice incorrect.