Assignment #2: Cardiovascular system
Please kindly use (APA, 7th ed.) references separately under each question.
Case Study:
Mr. K. is a 57-year-old man who consulted his physician after noticing marked leg pains while playing golf. He had previously noticed increasing fatigue and discomfort in his legs associated with moderate exercise. When sitting for extended periods with legs dangling, his legs became red, and sometimes his feet felt numb. His history indicates he smokes cigarettes and is chronically overweight. His blood cholesterol and other lipid levels are abnormal, and his physician suspects peripheral atherosclerosis as the cause of his discomfort.
Questions
. Discuss the development of atherosclerosis, including the predisposing factors in this
case and the pathophysiological changes.
. Discuss the complications that might develop in this patient.
. Discuss the treatments for all aspects of the patient’s condition, including slowing the progress of the atherosclerosis, maintaining circulation in the leg, and treating complication
Guide On Rating System
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1. The development of atherosclerosis involves a complex process that starts with injury to the inner lining of blood vessels, known as the endothelium. Predisposing factors in this case that contribute to the development of atherosclerosis include smoking, chronic overweight/obesity, and abnormal lipid levels.
Smoking is a significant risk factor for atherosclerosis as it damages the endothelium and promotes inflammation, leading to the formation of fatty plaques. Chronic overweight/obesity is also associated with increased production of inflammatory cytokines and oxidative stress, which contribute to the development of atherosclerosis. Abnormal lipid levels, such as elevated cholesterol, can lead to the accumulation of cholesterol in the arterial walls, promoting the formation of plaques.
The pathophysiological changes in atherosclerosis involve the accumulation of lipids, primarily cholesterol, within the arterial walls, leading to the formation of plaques. These plaques consist of fatty deposits, smooth muscle cells, and inflammatory cells. Over time, the plaques may grow in size and narrow the blood vessel lumen, reducing blood flow and oxygen supply to the affected tissues. In some cases, the plaques may rupture, leading to the formation of blood clots that can further block the blood vessels.
References:
- Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38-e360. doi:10.1161/CIR.0000000000000350
- Libby P, Loscalzo J, Ridker PM, Farkouh ME. Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week. J Am Coll Cardiol. 2018;72(17):2071-2081. doi:10.1016/j.jacc.2018.08.1039
2. Complications that might develop in this patient with peripheral atherosclerosis include:
- Peripheral arterial disease (PAD): Severe atherosclerosis in the legs can lead to reduced blood flow to the lower extremities, resulting in PAD. This may cause leg pain, difficulty walking (claudication), and in severe cases, non-healing wounds or ulcers.
- Critical limb ischemia (CLI): If the blood flow to the legs is severely compromised, it can lead to CLI. CLI is characterized by severe pain at rest, non-healing wounds, tissue death (gangrene), and limb loss.
- Coronary artery disease (CAD): Atherosclerosis is a systemic disease and can affect other arteries, including the coronary arteries that supply blood to the heart. CAD can lead to angina (chest pain), heart attack, or heart failure.
- Stroke: Atherosclerosis in the carotid arteries supplying blood to the brain can increase the risk of stroke.
References:
- Belch J, Hiatt WR, Baumgartner I, et al. Effect of fibroblast growth factor NV1FGF on amputation and death: A randomised placebo-controlled trial of gene therapy in critical limb ischaemia. Lancet. 2011;377(9781):1929-1937. doi:10.1016/S0140-6736(11)60394-2
- Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). J Am Coll Cardiol. 2006;47(6):1239-1312. doi:10.1016/j.jacc.2005.10.009
3. The treatments for all aspects of the patient's condition would include:
- Slowing the progress of atherosclerosis: Lifestyle modifications are essential, such as smoking cessation, weight reduction, and adoption of a heart-healthy diet. Medications may also be prescribed, including statins to lower cholesterol levels and antiplatelet agents such as aspirin to reduce the risk of clot formation.
- Maintaining circulation in the leg: Exercise programs that promote collateral circulation and improve blood flow may be recommended. This can include supervised walking programs and other forms of exercise. In severe cases, surgical interventions may be necessary, such as angioplasty or bypass surgery, to restore blood flow to the leg.
- Treating complications: For peripheral arterial disease (PAD), medications may be prescribed to relieve symptoms and improve blood flow, such as cilostazol or pentoxifylline. In critical limb ischemia (CLI), more aggressive interventions may be required, such as angioplasty, stenting, or surgical revascularization procedures. For coronary artery disease (CAD), treatment options include lifestyle modifications, medications (e.g., beta-blockers, ACE inhibitors), and possible interventions like coronary angioplasty or bypass surgery.
References:
- O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-Elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425. doi:10.1161/CIR.0b013e3182742cf6
- Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e726-e779. doi:10.1161/CIR.0000000000000471
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