Question

• Ernest Brown is a 55-year-old African American male with diabetes that is well controlled with medication. He has had occasional, transient episodes of chest tightness over the last two weeks, and the tightness returned one day while he was pushing a wheelbarrow full of leaves up a slight incline in his yard. Since the pain didn’t seem to be going away, he decided to call his doctor.

• The doctor’s receptionist had Ernest speak with the nurse, who asked Ernest about the quality and location of the chest tightness. Ernest replied that the tightness felt like a band across the center of his chest, with pain radiating through his left arm for a few seconds before subsiding. He added that this particular episode of chest tightness was triggered by exertion while doing yard work, and that he had had a couple of recent episodes while walking briskly uphill.

• The nurse, suspecting that Ernest’s angina might be a sign of an imminent heart attack, told him to hang up, dial 911, and tell the dispatcher he thought he might be having a heart attack. Ernest did so, and an ambulance arrived at his home within 10 minutes. The ambulance whisked him to the emergency room, where a team of physicians and nurses was waiting to administer the emergency department protocol for a suspected myocardial infarction. You are the receiving nurse.

Questions:

1. What are some risk factors for coronary artery disease? Identify the difference between 'modifiable' and 'non-modifiable'.

2. Identify the coronary arteries; what is each artery responsible for? Your own terms please - do not cut & paste this!

3. What is the difference between coronary artery disease and peripheral vascular disease (arterial only)?

Answer 1

Ans)Coronary Artery Disease: Atherosclerotic disease process that narrows lumen of coronary arteries resulting in ischemia to myocardium

Modifiable risk factors for Coronary artey disease:

- Hypertension, Hyperlipidemia, Smoking, Obesity, Stress,

Diabetes, Inactivity.

Non- Modifiable factors for Coronary artey disease:

- Age, Gender, Genetics

Difference between Modifible & Non-Modifiable factors for Coronary artey disease:

- The effect of these modifiable risk factors can be reduced if lifestyle changes are made.

- Non-Modifiable risk factors are: age ethnic background family history of heart disease cannot be changed as the older you are, the more likely you are to develop coronary heart disease or to have a cardiac event (angina, heart attack or stroke).

2) The two main coronary arteries are the left main and right coronary arteries.

• Left main coronary artery (LMCA). The left main coronary artery supplies blood to the left side of the heart muscle (the left ventricle and left atrium). The left main coronary divides into branches:

  • The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.

  • The circumflex artery branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the outer side and back of the heart.

• Right coronary artery (RCA). The right coronary artery supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm.

- The right coronary artery divides into smaller branches, including the right posterior descending artery and the acute marginal artery.

- Together with the left anterior descending artery, the right coronary artery helps supply blood to the middle or septum of the heart.

3)PAD is similar to coronary artery disease(CAD) Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. PAD most commonly affects arteries in the legs. Both PAD and coronary artery disease (CAD) are caused by atherosclerosis.

- Atherosclerosis can affect the arteries in the heart, legs, brain, kidneys and other organs. The type of atherosclerosis known as peripheral arterial disease (PAD), peripheral vascular disease (PVD) and lower extremity vascular disease occurs in the vessels that carry blood to the arms.