Cellular and Molecular Pathological Mechanisms in the Failing Heart Article

Cellular and Molecular Pathological Mechanisms in the Failing Heart - Article Example In many cases, however, it is not possible to arrive at a specific etiologic diagnosis, and thus it is often more desirable to classify the cardiomyopathies into one of three types dilated, restrictive, hypertrophic on the basis of differences in their pathophysiology and clinical presentation. About one in three cases of congestive heart failure (CHF) is due to dilated cardiomyopathy, with the remainder the consequence of coronary artery disease. Left and/or right ventricular systolic pump function is impaired, leading to progressive cardiac enlargement and hypertrophy, a process called remodeling. Symptoms of CHF typically appear only after remodeling has been ongoing for some time. There is, however, no close correlation between the degree of contractile dysfunction and the severity of symptoms. Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy, typically of a nondilated chamber, without obvious cause such as hypertension or aortic stenosis. Two fe atures of HCM have attracted the greatest attention: (1) asymmetric left ventricular hypertrophy, often with preferential hypertrophy of the interventricular septum; and (2) a dynamic left ventricular outflow tract pressure gradient, related to a narrowing of the subaortic area as a consequence of the midsystolic apposition of the anterior mitral valve leaflet against the hypertrophied septum. The hallmark of the restrictive cardiomyopathies is abnormal diastolic function. The ventricular walls are excessively rigid and impede ventricular filling. Myocardial fibrosis, hypertrophy, or infiltration due to a variety of causes is usually responsible. The infiltrative diseases, which represent important causes for secondary restrictive cardiomyopathy, may also show some impairment of systolic function. The inability of the ventricle to fill limits cardiac output and raises filling pressure. Therefore, exercise intolerance and dyspnea are usually the most prominent symptoms. As a result o f persistently elevated venous pressure, these patients commonly have dependent edema, ascites, and an enlarged, tender, and often pulsatile liver. The jugular venous pressure is elevated and does not fall normally, or it may rise with inspiration (Braunwald, 2005, 13-78). The current concepts in the cellular mechanism of established cardiac failure suggest that a failing heart is in an energy-depleted state. There are ongoing debate and continued research in this area, and it has been suggested that there is an imbalance between energy production and energy utilization. Human atrial myocytes have been found to be responsive to a swelling-activated outwardly rectifying chloride current. Although the exact function has still not yet been delineated, it has been suggested that these chloride currents are thought to modulate cardiac electrical activity. It has also been suggested that the hemodynamic perturbations responsible for the development of CHF and cellular hypertrophy place myocytes under mechanical stress. This, in turn would lead to complex cellular remodeling and activation of signaling systems at the intracellular levels. In a gross level, congestive heart failure is associated with cardiomyopathy, where the congestive heart failure is the resultant of cardiomyopathy. In cardiomyopathy, due to weakness of muscles of the heart, heart is not able to pump

Choose a professional career path such as CIMA, ACCA. and critical Essay

Choose a professional career path such as CIMA, ACCA. and critical evaluation of two professional bodies appropriate for your ca - Essay Example This body has an aim of ensuring that that the growth of accountancy is that of influence as well as reputation. Membership Requirements In terms of membership, CIMA offers two grades, which include Associate and fellow. This means that for associate, an auditor for instance has to pass the qualifying examinations of the institute, should have three years of qualifying practice, which has been proved by being signed by witnesses. Two persons have to propose and second the member. As for the fellow, the auditor, being a member, should have the necessary experience from the senior level (Gowthorpe, 2005). On the other hand, a candidate should register as a member so as to undertake a professional scheme qualification. If a member completes the examination successfully, he/she therefore is transferred to the affiliate status. From this status is when a member is supposed to demonstrate through an application form that they have acquired a practical and supervised experience in accountan cy hence becoming an auditor . They should also have acquired the competence that is of standard level in auditing. Also, after a membership of five consecutive years, a senior membership is automatically awarded. ACCA offers its members the access to the Association of Corporate Treasurers membership. The United Kingdom’s Security & Investment Institute also recognizes ACCA members such as financial accountants (Page, 2006). The members are allowed to take International Taxation advanced diplomas at Chartered Institute of taxation. As for the CIMA, members gain recognition by the Society of Management Accountants of Canada. It has a qualification program with New Zealand Institute of Chartered Accountants. Qualifications In terms of qualification, ACCA provides a variety of diplomas and certificates at a foundation level. This is generally known as accountancy foundations. It offers an entry for individuals who want to pursue a career in finance and accounts but are new to t his field and do not meet the ACCA qualification entry requirements. Other qualifications include International auditing certificates, Financial management diplomas, Certificate and Diploma in International Financial Reporting, for ACCA full membership, individuals are offered MBA from Oxford University (Mike, 2008). CIMA offers a syllabus that is structured to motivate accountants pursuing their career in finance. Therefore, the students are at a position acquire Diploma in management accounting, Advanced management accounting diplomas as well as business accounting certificate. However, this body takes a long process when marking the examinations. Before the examinations are marked, a meeting is held between the examiner and the marker whereby they discuss into details of the marking scheme. The examiner is at a position to moderate the marking system at a closer range hence reviewing the scripts of marking. Differences There are a number of differences between a financial account ant from ACCA and an auditor from CIMA. ACCA for instance is a global organization that caters for financial accountants on a professional level while CIMA offers professional management in accounts internationally. CIMA deals with management on corporate strategy, budget making and variance analysis. On the other hand, ACCA concentrates on the technical accounting that best suits tax accountants, auditors as well as corporate