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A Narrative of a Revolutionary Soldier
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A Narrative of a Revolutionary Soldier
Joseph Plumb Martin was born in November 21st of the year 1760 in Becket, Massachusetts. He was the son to Reverend Ebenezer Martin and Susannah Plumb. When he was seven years he was sent to live with his grandparents in Milford, Connecticut and because his family was well to do, Martin was privileged to receive a well-rounded education to which included reading and writing. Plumb Martin was a soldier in the Continental Army and as well a Connecticut Militia during the American Revolutionary War. During the war, Martin possessed the rank of private for most of the war. After the war, Martin considering that he was educated, was devoted to writing a memoir of his experiences as a soldier in the Revolutionary War. The narrative that punished his encounters was rediscovered in the 1950s and became one of the most valuable resources for the historians in the attempt to understand the conditions of a common soldier during the era. Besides understanding the conditions of war, the historians were as well enlightened about the battles that Martin participated.
When Martin was 15 year of age in the year 1775, he was eager to join the revolutionary war just like most of his age mates in the region following the Battles of Lexington and Concord. At first, his grandparents were opposed to the idea but later agreed after Martin’ threats to run away and join the naval ship as a privateer in case the grandparents didn’t allow him to leave. In June 1776, Martin joined the Connecticut Militia and was assigned duty in the New York region as he arrived just before the opening of the British Long Island Campaign. Martin’s first tour of duty ended in December of the same year 1776, and therefore he was forced to return home before the Battles of Trenton and Princeton. Plumb Martin later reenlisted in the Continental army in April 1777 and this time signed for the duration of the American Revolutionary War. Martin served with the 17th Continental Regiment under the command of General James Varnum.
Joseph Plumb Martin participated in various notable battles that included the Battle of White Plains, Battle of Brooklyn, and the siege on Fort Mifflin as well as the Battle of Monmouth. Plumb Martin was encamped at Valley Forge, he witnessed John Andre’s escort for his prosecution, and as well he was present during the climatic Siege of Yorktown. In 1778, Marin was assigned to the Light Infantry, and here he attained the rank of Corporal. In the summer of 1780 under the directives of Washington for the formation of Corps of Sappers and Miners, Martin got a recommendation by his superior officers to be a non-commissioned officer of the regiment. After being selected, Martin was promoted to the rank of a Sergeant. Unlike the duties in Yorktown, the corps were commissioned and made responsible for the digging of the entrenchments for the Continental army. During the battle, the corps were also a Vanguard for the regiment command by Alexander Hamilton and were therefore mandated with the duties of clearing the fields of sharpened logs that were known as abates would be able to capture Redoubt number ten.
Plumb Martin was discharged from his duties in June of the year 1783, just a few months before the Continental Army was disbanded in October. From there, Martin became a teacher and taught in the New York for a year eventually settling in Maine’s frontier becoming one of the founders of the town of Prospect that is near the modern-day Stockton Springs. He was known locally as being a farmer, a selectman and as well a Justice of the peace and town clerk, one of his last positions that he served for 25 years. He married Lucy Clewely 1794, who was born in 1776 and together had five children. Plumb Martin wrote many stories and poems, and one of the most famous is the narrative of his experiences during the revolutionary war in the 1830s.
When the Revolutionary war overwhelmed his country in the year 1776, Plumb Martin was just like any other sixteen-year-old kid and just like the other boys, and he was forced to join the Rebel Infantry. Unlike the other soldiers in the battle, Marin recorded his trials and tribulations after forty-seven years later in the memoir named A Narrative of a Revolutionary Soldier: Some of the Adventures, Dangers, and Suffering of Joseph Plumb Martin. In the true American style, the Narrative contradicts the standards of the time and rather than worshipping the Revolutionary Army for its moral perfection as well as flawless character, the Narrative provides an unflattering and realistic perception of the burdens and problems and through the book, Plumb Martin offers a staggering truthful image of the Revolutionary War.
Plumb Martin entered the Revolutionary war at a young age with the primary aim of protecting his country demonstrating his patriotism while at the same time wanted to experience the adventures in the war that was worth telling. Martin was devoted to fighting due to his patriotism and therefore engaged in the battle dutifully from 1776 to 1783. Together with his company, they participated in seven battles, and some of them include the Siege of Yorktown, Battle of Princeton and Fort Mifflin. Throughout the six years of service that Martin served as a Militia, he was lucky to escape serious wounds and capture and only got severely ill at a single occasion and this incidence exhibit the stunning physical impunity for the pre-medically competent times. Martin’s battles both minor and major were haunted by his ‘constant companion’ that is hunger that was punctuated by the almost unbearable cold during the night.
Throughout the Narrative, Plumb Martin disapproves the conception that war is combative as he describes arduous marches as well as tedious waiting far more than the battle itself, downplaying bloodshed while at the same time highlighting the daily struggles. The narrative being a historian report indicate that the revolutionary army was usually short on the supplies, but their deprivation is often minimized in the wake of the Battles such that of Princeton and New York battles. The author of the narrative brings to light the plight of the Revolutionary war soldiers through his story of the Continental Congress’ overlooking the troubles of the army during the winter of the year 1777. Where the Congress provided the military with a shockingly sparse thanksgiving dinner that constituted of a tablespoon of vinegar and a quarter cup of rice to the hungry soldiers indicating that the soldiers were starved as their welfare was not well catered. However, besides being malnourished, the revolutionary soldiers were not well furnished with clothes. According to the narrative, the horror stories of the 1777-78 Valley Forge winter report was only part of the deprivations that the revolutionary soldiers were subjected to and he narrates that men did not only march with their bloody bare feet but also went without socks, pants and even coats.
Apart from being honest regarding the nature of the war, Plumb Martin discloses the bare facts that concerned the soldiers fighting in the war. Ever since the end of the revolutionary war, the revolutionary officers and the footmen were lauded for their honesty, chivalry and near perfection, but unfortunately according to Plumb Martin, the stories exaggerate as it is proven by his description of the officers’ unfair treatment of their soldiers, disrespect from the citizens as well as their questionable treatment of both parties. The civilian distrust of the war soldiers were according to Martin was sadly founded as, although the American soldiers never abused the countryside as their enemies, they often scavenged or even stole from the available farms. According to Martin’s accounts, he himself admitted leading numerous of such raids to the farms to scavenge for food. As a result of their overbearing handling of their soldiers, the officers occasionally received harsh treatments from their subordinates. Plumb Martin narrates of several younger soldiers’ packing a musket with black powder and then setting it off near their elderly captain’s tent to make him terrified as a result of being mistreated.
Plumb Martin wrote the ‘Narrative of a Revolutionary Soldier’ in a firsthand account, and therefore the reader is made to easily believe in Martins accounts as they are stimulated I the memoir. The reason is that when a narration is provided in the first account, it enables the reader’s trust the author as the author is considered as a credible source of truthful information as they provide information according to their experiences with the events. Therefore, with Plumb Martin detailing the problems to which the foot soldiers of the revolutionary war passed through that included neglect, starvation, disrespect, humiliation and harsh treatment. In overall, the Narrative is a realistic book that is recorded in unusual point of view and commonly readable details as the nineteenth-century authors were too lengthy in descriptions with an example of Adventures of Oliver Twist by Dicken. The book by Martin uses a straightforward language that is enough to make sense to a reader of the 21st century. The potential problem with the narrative is the repetition in storytelling as the reader is taken into circles of the problems such as freezing, starving marching and waiting, although they provide an accurate account of the events as they happened during the war.
Work Cited Leckie, Robert. George Washington’s War: the saga of the American Revolution. HarperCollins, 1992.
Martin, Joseph Plumb. A Narrative of a Revolutionary Soldier: Some Adventures, Dangers, and Sufferings of Joseph Plumb Martin. Penguin, 2010.
Washington, George, and Continental Army. The American Revolution: 1775-1783. Vol. II. Boston: Little, Brown, 2014.
Benefits of a Criminal Justice Degree
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Benefits of a Criminal Justice Degree
Many support the idea that a solid education is vital for one to succeed in any career. The field of criminal justice has a wide range of professions, which raises the question of what level of education is required to get into the field and go up the career ladder. Many careers in the field of criminal justice only require a high school diploma or a GED. To answer the question as to whether a college degree is necessary to succeed in criminal justice, it is only basic to describe success. As mentioned, since many careers in this field do not require a college degree, then success in any of them would render the degree not very important. However, I define success as going up the ladder from a graduate level. So this essay will discuss why a college degree equals success in the field of criminal justice.
For any field and success in every path in life, a college degree is beneficial in various ways. In order to go up the career ladder in the field of criminal justice, advancement in education is also necessary. This means that obtaining a degree before gaining employment will be instrumental to career growth since the next step will be a master’s degree, which is always a basis for most promotions. In comparison to a person that begins with a high school diploma, the one with a college degree will most likely be promoted faster. A college experience is also very beneficial to the achievement of success besides those of having that level of education. Spending time in an academic institution is very crucial to laying the groundwork for future success. There is the aspect of creating contacts with people that will hold certain positions in the same field in the future. The environment created by college enables students to hone and perfect skills that will be instrumental in the field of criminal justice regardless of the exact job. A good example is writing a report, which is a crucial part of any job in criminal justice.
Subjects that are taken through the course of the degree give the graduate an opportunity to develop articulation skills and the ability to defend points of view. Considering the nature of this field, articulation is very important in dealing with people, either the general public or those within a potential chain of command. A career in criminal justice means scrutiny in every single way one conducts themselves or takes action or inaction. In order to succeed in the field then, one should be able to positively deal with criticism and give feedback as to why they have taken this point of action.
The most important college-level class one can take in the field of criminal justice is interpersonal communications. The ability to operate in a field filled with various sorts of personalities can only translate to either failure or success or even in extreme circumstances getting home safely. Tests are a major assessment tool to measure the performance of various criminal justice professionals. These tests also include written ones, which means test-taking in college is essential and applicable in the field.
The field of criminal justice is extensive, with many career opportunities. It can be a point of entry into law studies or send one into the field of politics, advocacy, law enforcement, and academia, to mention a few (TBS). Going into the prestigious and more competitive world of corporate law means a rise in social status. This is because it means huge salaries and a rise in income, which translates to a different level of social class. Also, the field of criminal justice sends one to ethically driven causes such as politics and public policy. Politicians are respected figures in society and hold a high position in society. Within any social class, occupation is essential because it offers financial rewards, stability, and other benefits. With a degree in any field of criminal justice means movement from the lower middle class to upper-middle class, which is made of lawyers to the upper social class, made up of the elite who include corporate lawyers, politicians, and capitalist elite.
A path in the field of criminal justice most often leads to entry into the legal field, with some majors going into law school to become lawyers. A degree in criminal justice is a crucial steppingstone to becoming a lawyer. Many politicians start as lawyers before running for office mostly because of their ability to effectively articulate themselves and their extensive knowledge of the law. In the same manner, investigation groups and think tanks on any political concern or issue have at least one individual with criminal justice expertise, if not a lawyer (Lesley). In addition, the contributory use of criminal justice as a basis of democratic projects has evolved over the eyes, putting criminal justice majors at the center of politics. Criminologists have played a crucial role in political projects and have been influential in shaping the political terrain. This is a demonstration that the field of criminal justice has a direct connection with politics, and getting up the political ladder is easy with a criminal justice basis.
Because of the nature of the field of criminal justice, certain skills and traits are essential to longevity and growth in whatever career pattern affiliated to the field one chooses. Learning does not stop with the degree, which makes continuous learning and development important to achieve success. The changes in technology make it essential for students in law enforcement to create a plan that helps in adapting to a landscape that is under continuous evolution (Malvik). With the hope of moving into a leadership position, higher education is necessary.
Essentially, the course of action, in addition to a bachelor’s degree in order to advance in the field of criminal justice, is to hone certain essential skills. These skills include critical thinking because of the nature of the field, which presents one with high-pressure situations requiring quick reaction. Being able to adjust with speed and calculate the outcome of certain actions is key to accomplishment in this field. The other skill is ethical leadership. The field of criminal justice is filled with critical dilemmas, which calls for the ability to uphold moral principles. Acting in violation of ethical rules may lead to the loss of credibility, job, and in worst cases facing litigation. Verbal and non-verbal communication is another key skill since experts in this field find themselves in circumstances where they are required to make public speeches or conduct briefings, stating the status of a certain case. Non-verbal communication skills apply in reading the body cues presented by another person, be it a criminal or a witness. It would not also be bizarre to want to be physically fit because of safety reasons.
Works Cited
Lesley McAra, Can Criminologists Change the World? Critical Reflections on the Politics, Performance and Effects of Criminal Justice, The British Journal of Criminology, Volume 57, Issue 4, July 2017, Pages 767–788, https://doi.org/10.1093/bjc/azw015Malvik, C. “Experts Explain Everything You Need to Know About Careers in Criminal Justice.” 13 July 2014, www.rasmussen.edu/degrees/justice-studies/blog/everything-you-need-to-know-about-careers-in-criminal-justice/.
TBS. “What Can You Do with a Criminal Justice or Law Degree?” TheBestSchools.org, The Best Schools, 17 Sept. 2019, thebestschools.org/degrees/criminal-justice-law-degrees/. Accessed 29 Nov. 2019.
Literature Review Acute Coronary Syndrome
Literature Review: Acute Coronary Syndrome
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Acute coronary syndrome is caused by lack of adequate blood in the heart. In particular, the condition occurs when the coronary arteries are blocked hence limiting their ability to supply oxygenated blood to the heart muscles. Unstable angina refers to the chest discomfort that is caused by the lack of enough blood flow. Unstable angina is more severe compared to stable angina but less severe than myocardial infarction. Unstable angina which is also known as the angina pectoris is characterized by pain in the chest. When the left anterior descending artery is occluded, the walls of the left ventricle, the interventricular septum and other parts are affected. When the right coronary artery is affected the right atrium and the left ventricle become ischemic. On the other hand, when the circumflex artery is occluded the left ventricle, atrium, fasciculus, and the bundle branches become ischemic.
The etiology of this condition focuses on the formation of atherosclerotic plaques. The process starts with endothelial dysfunction. Endothelial dysfunction refers to a condition whereby the inner linings of the endothelium fail to function properly. Remember, the endothelium plays an important role in regulating blood clotting but this function is likely to be affected by several conditions including metabolic syndrome, hypertension, smoking and inactivity. According to Balasubramaniam, Viswanathan, Marshall and Zaman (2012) endothelial dysfunction is characterized by an imbalance between vasodilating and vasoconstricting substances, and an increase in leucocyte adhesion, hence leading to vascular reactivity. Ultimately, endothelial dysfunction leads to atherosclerosis.
According to the American Heart Association, more than a million people are affected by this condition every year. In 2006 alone, more than 1.4 million patients were discharged with a primary or secondary diagnosis of acute coronary syndrome. Currently, there are more than 7 million people living with this condition. Beside death, coronary heart disease can lead to premature, chronic disability to the affected patients. Following a discharge, patients suffering from acute coronary syndrome require re-hospitalization within the first six months. One in every five patients diagnosed with non-ST elevation myocardial infarction and ST-segment elevation, dies after hospitalizations. In total, acute coronary syndrome accounts for half of all mortality related to cardiovascular diseases. The cost of rehabilitating patients with acute coronary syndrome is enormous. The direct costs of treatment are estimated to be $75 billion while the indirect costs of treating patients with acute coronary syndrome are more than $142 billion.
A number of studies have been conducted to examine the threat of Acute Coronary Syndrome among the American population. One such study was conducted by Doyle, Simon, and Stenzel-Poore (2008) using a Behavioral Risk Factor Surveillance. Using self-reported data, the researchers found out that the Southern Eastern states are the ones that are heavily affected by the Acute Coronary Syndrome menace. The study analyzed the risk factors that are responsible for the high prevalence rates in the South Eastern states. One of the risk factor that was examined is the ethnic background and socioeconomic status. The southern eastern part is mainly occupied by minority communities including the blacks and the socioeconomic status of the occupants there is much lower compared to the rest of the nation. The high prevalence rate can also be explained by the lifestyle factors such smoking. The southeasterners also suffer from contributing diseases such as diabetes, coronary heart diseases and hypertension. Due to the high prevalence rates, death rates as a result of Acute Coronary Syndrome are also significantly higher, in the southeastern regions, compared to the other parts around the nation.
Acute Coronary Syndrome has affected other developed countries. In the UK, Acute Coronary Syndrome is a leading cause of disability, and a leading cause of death. Currently, there are around 1 million Acute Coronary Syndrome survivors while an estimated 150,000 people are diagnosed with Acute Coronary Syndrome every year. The majority of those affected by Acute Coronary Syndrome in the UK are the elderly and the leading risk factor is obesity. In England, Northern Ireland, Scotland and Wales, 25% of the whole population is considered obese. The levels of activity among the residents in these four countries are also very low and this explains why Acute Coronary Syndrome is responsible for a significant percentage of deaths that are reported in the country. Overall, £ 8 billion is spent in Acute Coronary Syndrome-related costs.
Developing countries have not also been spared either. In India the prevalence of Acute Coronary Syndrome has been on the rise and this occurrence has been attributed to an increase in the aged population. In Cuba, the crude mortality from Acute Coronary Syndrome is 84 per 100,000 population while in the neighboring countries it is the second leading cause of death (Bonita & Beaglehole, 2871). Just like in India, a significant percentage of the total population in Cuba is made up of elderly people. Incidences of Acute Coronary Syndrome in the developing countries are attributed to several factors. Firstly, low and medium income earning countries account for almost 80% of all chronic noncommunicable diseases that are reported in the world. At the same time, the local population in the developing countries continues to engage in lifestyle choices such as eating high-fat diets, smoking and living a sedentary lifestyle. As the residents continue to adopt the western lifestyle it is expected that the prevalence of Acute Coronary Syndrome will continue to rise. These statistics illustrate to us that Acute Coronary Syndrome is a serious condition which takes huge resources to rehabilitate patients. In addition, the disease has an adverse effect due to the loss in productivity. It is on this basis that it becomes important to evaluate the events surrounding the disease and how it can be prevented and managed.
Literature review
Acute cardiovascular syndrome is a form of cardiovascular disease and is a leading cause of death in the America. Death results when the atherosclerotic plaque breaks up hence stimulating platelet aggregation and thrombus formation. The thrombus formed then prevents myocardial perfusion. Remember, the myocardial cells require oxygen to function properly but the formation of the thrombus restricts the supply of the oxygen hence increasing the myocardial demand for the oxygen. As a result, the ischemic tissues become necrotic leading to decreased renal perfusion. Ultimately, decreased renal perfusion stimulates the release of renin, angiotensin, aldeosterone, antidiuretic hormone hence increasing workload of myocardium.
Balasubramaniam, Viswanathan, Marshall and Zaman (2012) evaluated the role of the endothelial cells in the atherosclerosis process. In the article Balasubramaniam, Viswanathan, Marshall and Zaman Balasubramaniam (2012) argues that endothelial dysfunction plays a pivotal role in the expression of atherosclerosis. When the endothelium becomes impaired it fails to maintain vascular homeostasis. As a result, a number of abnormalities are experienced and they include loss of nitric oxide, over-production of vasoconstrictors, and reduction of the ability to control inflammation, thrombosis and cell growth. The endothelium also plays the role of producing vasodilators such as nitric oxide, and prostacyclin while regulating the effect of vasoconstrictors such as endothelin-1 and angiotensin. The loss of vasodilators and over-production of vasoconstrictors affects the integrity of the arteries. One such vasoconstrictor is angiotensin. Angiotensin not only plays an important role in the loss of normal arterial compliance and patency, but it also mediates the plaque weakening process in a number of ways. Firstly, it leads to the up-regulation of the IL6 gene which is produced by the plaque microphages. Secondly, it leads to the up-regulation of the MMP genes which then lead to the degradation of the plaque fibrous cap. Thirdly, it leads to the activation of the nitrogen-activated protein kinase cascades and tyrosine kinases. Finally, it mediates the stimulation of neo-vascularisation.
In the article, Balasubramaniam, Viswanathan, Marshall and Zaman (2012) further look at the impact of the risk factors such as diabetes in the progression of atherosclerosis. In their view, diabetes mellitus is a strong predictor, and the studies that have been conducted indicate that patients suffering from diabetes have very a little opportunity of recovering from Acute Coronary Syndrome. Mortality rates for diabetes mellitus patients with acute myocardial infarction are also high. In this article, they also look at the role of endothelial NO synthase in the inflammation process. As a vasodilator, eNOS plays an important plays an important role in preventing leukocyte (Balasubramaniam, Viswanathan, Marshall & Zaman, 2012) adhesion while maintaining the antiflammatory state of the endothelium. However, the Acute Coronary Syndrome leads to the low production of eNOS and the endothelial cells are activated to produce vascular cell adhesion molecules such as the VCAM-1 and ICAM-1. These vascular cell-adhesion cells promote the adhesion of the leukocytes to the endothelial surface.
In this article, Balasubramaniam, Viswanathan, Marshall and Zaman (2012) further argue that diabetes increases the platelet aggregation and adhesion process in several ways. Firstly, the condition leads to reduced platelet membrane fluidity. Secondly, the condition leads to increased production of thromboxane, hence increasing platelet sensitivity. Thirdly, it increases the expression of platelet adhesion molecules and the number of platelets. These two actors play an important role in the pro-coagulant activity. Fourthly, diabetes increases the expression of platelet surface receptors and generation thrombin. Fifthly, diabetes mellitus reduces the sensitivity of the platelets to the effects of the vasodilators. Sixthly, platelets of patients with diabetes mellitus are rich in cytokines and chemokines which contribute to inflammation of the endothelium. These findings are supported by Al Thani et. al. (2012) who concluded that diabetes is an independent predictor for presence of polyvascular diseases and Acute Coronary Syndrome.
Another study that was conducted by Zhong, Tang, Zeng, Wang, Yi, Meng, Mao, and Mao (2012) investigated the role of cholesterol content in atherosclerotic plaque progression. Zhong et al. (2012) used a sample of 136 participants. The researchers assessed the cholesterol content of erythrocyte membranes. It is well acknowledged that cholesterol plays an important role in plaque formation. The key feature of the plaque formation is the erythrocyte membrane. Erythrocyte membrane is a key source of cholesterol in plaques. Their findings are supported by Giannoglou,Koskinas, Tziakas, Ziakas, Antoniadis, Tentes, and Parcharidis (2009) who found out that CEM in Acute Coronary Syndrome patients is significantly higher that in patients with stable angina pectoris. In the study, Zhong, Tang, Zeng, Wang, Yi, Meng, Mao, and Mao (2012 also (2012) investigated some of the factors that determine the size of the plaque in the artery. Obviously, the amount of the cholesterol determines the size of the lipid core. The researchers concluded that erythrocytes played a major role in plaque expansion by increasing the lipid content. In addition, they argued that cholesterol encouraged apoptosis of macrophages and formation of foam cells.
The role of the low-density lipoproteins as a cause of Acute Coronary Syndrome was investigated by Meisinger, Baumert, Khuseyinova, Loewel, and Koenig (2005). Very Low-density lipoproteins are secreted from the liver, and are then converted to low-density lipoproteins (LDLs). LDLs may accumulate in the artery wall if their rate of removal is low (Meisinger, Baumert, Khuseyinova, Loewel, & Koenig, 2005). The LDLs stimulate the endothelial cells to express the monocyte chemotactic protein-1 (Meisinger, Baumert, Khuseyinova, Loewel, & Koenig, 2005). MCP-1 then attracts monocytes from the blood. In addition, LDLs encourages differentiation of monocytes into macrophages. Macrophages promote the formation lipid-cell foam cells, which are the hallmark of the atherosclerosis process. Following this narration it is rather apparent that low-density proteins mark the start of atherosclerosis process, and its subsequent progression.
Plaque rupture
According to Kumar and Cannon (2009) the molecules in the endothelium mediate the adhesion of leukocytes on the endothelial surface. The monocytes penetrate the endothelial wall, where they interact with oxidized LDL, transforming into foam cells. The foam cells produce cytokines and other substances that maintain atherosclerosis progression. The plaque usually has a thin fibrous cap which is destabilized by the inflammation cells such as the monocytes, macrophages and T-cells. In the article titled, Coronary events, Armin, Masataka, Renu and Valentin (2012) revisit how the plaque forms and how it later erupts. An atherosclerotic plaque normally has a large necrotic core but a small layer of the fibrous cap. The expansion of the atherosclerotic plaque is facilitated by the accumulation of free cholesterol, and macrophage infiltration. The fibrous cap only has a few smooth muscle tissues and is often inhabited by macrophages and T lymphocytes. Once the fibrous cap erupts, it exposes the thrombogenic materials to the blood stream. Following the rupture of the plaque, thrombi are formed. It is the rupture of the fibrous cap that leads to the development of unstable angina and myocardial infarction.
A lot of research has focused on how the plaque ruptures. One likely cause is the accumulation of T-lamphocytes and microphages-derived foam cells which secrete cytokines and proteolytic enzymes leading to the depletion of smooth muscle cells. The apoptosis of smooth muscle cells is promoted by the mast cells which are abundant in the plaque. The reduction of the smooth muscle cells impairs the repair process. Remember, smooth muscle cells produce the cap-stabilizing collagen and so a significant reduction of the cells is likely to have deleterious effects. Plaque rupture is also facilitated by the blood flow-induced shear stress. It is assumed that as the plaque grows, the tensile stress on the plaque shoulders increases hence leading to fissuring and subsequent rupturing. Armin, Masataka, Renu and Valentin (2012) found out that areas of low shear stress had advanced plaques than areas with high stress. Armin, Masataka, Renu and Valentin (2012) further notes that not all plaque ruptures lead to coronary events.
Armin, Masataka, Renu and Valentin (2012) examined the atherosclerotic process and the effect it has on the size of the artery. During the initial stage, the size of the artery is usually normal. In the second stage, as the plaque formation progresses, the artery remodels itself to avoid lumen encroachment. In the third stage, the plaque ruptures and hemorrhages leading to formation of intramural thrombi. Armin, Masataka, Renu and Valentin (2012 notes that mostly the plaque heals and continues to grow. Alternatively, the thrombogenic materials may be embolized distally leading to coronary arterial insufficiency or asymptomatic micro-infarctions. In the fourth stage, if the right conditions exist, the rupture of the plaque leads to the occlusion of the affected arteries.
In the article, Armin and his colleagues also looked at the interplay of factors that contribute to acute coronary event risk (2012). One factor is plaque burden which is determined by the blood viscosity, platelet function, stress and smoking (Armin, Masataka, Renu & Valentin, 2012). The other coronary plaque characteristic is lumen encroachment which depends on shear stress, circadian variation, obesity, catecholamine surge and pollution (Armin, Masataka, Renu & Valentin, 2012). Other coronary plaque characteristics include lesion locations, plaque composition, plaque biology, plaque configuration, endothelial dysfunction and plaque remodeling (Armin, Masataka, Renu & Valentin, 2012).
On their part, David and Valentin (1999) looked at the activities surrounding the atheromatous plaques. The formation of plaques according to David and Valentin (1999) can be traced to the early lesions. Early lesions then grow bigger as the extracellular lipid and cholesterol content increase and fibrous cap grow thin. This development according to David and Valentin (1999) occurs in 5 phases. During phase 1 the development of lesion types I-III occurs while in the phase 2, lesion types IV and Va develops (David & Valentin, 1999). Plaque disruption starts from phase 3, eventually leading to the growth of more complicated plaques. The acute coronary syndrome occurs in phase IV, when plaques are more complicated (David &Valentin, 1999). However, plaques may fail to rupture and occlude the affected arteries. Such plaques characterize the last stage of the plaque development.
Clinical sequellae and symptoms
The eruption of the fibrous cap exposes the content of the plaque to the blood elements. In addition, an alteration of the blood flow is experienced around the ruptured plaque and the blood flow supporting myocardial distal is reduced (David &Valentin, 1999). Vasoconstriction at the site of the ruptured plaque makes coronary events to become much more severe. (David &Valentin, 1999) If the ruptured plaque does not significantly disrupt the flow of the blood, only an asymptomatic progression of the lesion is experienced (David &Valentin, 1999). On the other hand, if the rupture leads to complete vessel occlusion, acute myocardial infarction results (David &Valentin, 1999). The common symptoms of Acute Coronary Syndrome include chest pain, arrhythmia, shortness of breath, fatigue, weakness, heart palpitations, nausea, numbness, confusion, slurred speech, vertigo and headache.
Diagnosis
Detection of atherosclerosis is one of the main objectives of the diagnostic tools. One such advancement is the use of plasma markers. One of the markers that have been used widely is the C-reactive protein and the lipoprotein associated phospholipase A2. Such markers are used to predict coronary events. Using peripheral blood has become popular due to the low cost that is associated with this process. An alternative method that is used in diagnosing coronary patients is the non-invasive imaging. Some of the imaging tools that can be used for identifying vulnerable carotid plaques include: ultrasound, MRI, nuclear imaging and X-Ray multi-detector. A CT angiogram and a nuclear scan could also be used to check the site of rupture and identify whether the arteries are constricted or blocked. Other diagnostic tests include an electrocardiogram, blood tests, chest X-ray, and coronary angiogram.
Interventions
Reperfusion therapy
In the article titled, Acute coronary syndromes: diagnosis and management, Cannon and Kumar (2009) looks at the interventions for the acute coronary syndrome. Reperfusion therapy has been found to improve patient outcomes. The efficacy of reperfusion therapy in acute coronary syndrome was tested in a study that was conducted by Desai (2008). The 80 participants in this study were all Acute Coronary Syndrome patients. The two researchers also compared the efficacy of the percutaneous balloon angioplasty and systematic thrombolysis. The two interventions were found to increase systolic and left ventricle functions.
Antithrombotic therapy
According to Kumar and Cannon (2009) the aim of this intervention is to maintain the patency of the infarct-related artery. Antithrombotic therapies are augmented by anti-platelet strategies such as aspirin and glycoprotein IIb/IIIa antagonists. Antianginal therapy could also be used and use of nitrates to reverse the vasospasm, reduce the coronary blood flow at the site of rupture and the myocardial oxygen demand.
Coronary surgery and angioplasty
It is apparent that administration of anti-platelet and anti-thrombotic drugs improves the chances of survival to the patients. These drugs are often used before percutaneous coronary or surgery revascularization is performed. The coronary surgery is performed to bypass the affected portion of the coronary artery. The grafted artery goes around the area with the plaque, a process that creates a new path for oxygen-rich blood. The efficacy of coronary artery bypass surgery is supported by a study that was conducted Kumar and Cannon (2009). All the participants in this study had ST-segment elevation myocardial infarction. The result of the study indicates that high-risk patients who undergo surgery intervention have very high chances of survival. An alternative to the bypass surgery is the percutaneous coronary surgery otherwise known as coronary angioplasty or balloon angioplasty. The process entails using a catheter with a balloon at the tip. Once in place, the balloon inflated to compress the plaque against the artery wall. This process targets unstable plaques which have thin fibrous caps, lipid full macrophages, and deficient smooth muscle cells. During balloon angioplasty, a stent is used to maintain the patency of the occluded arteries.
References
Al Thani, H., El-Menyar, A., Alhabib, K., Al-Motarreb, A., Hersi, A., Alfaleh, H., Asaad, N., Saif, S.A., Almahmeed, W., Sulaiman, K., Amin, H., Alsheikh-A., Alnemer, K. & Suwaidi, J. (2012). Polyvascular disease in patients presenting with acute coronary syndrome: its predictors and outcomes. Scientific World Journal, 2012, 284851
Armin, A., Masataka, N., Renu, V., & Valentin, F. (2012). Acute coronary events. Circulation, 10(1), 1147-1156
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