Question

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.

1. Discuss the development of atherosclerosis, including the predisposing factors in this case and the pathophysiological changes. (See Atherosclerosis.)
2. Discuss the complications that might develop in this patient. (See Atherosclerosis—Pathophysiology, Signs and Symptoms.)
3. 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 complications. (See Atherosclerosis—Treatment.)

Mr. K reports that the sharp pain started about 2 days ago and it has gotten so bad that he cannot lie down. He rates the pain as an 8 on a scale of 1 to 10, and it radiates to his neck and back. It is much worse when he takes a deep breath, but leaning forward seems to help him. Family history is significant for heart disease and hypertension

4. What labs would be helpful in confirming or ruling out a myocardial infarction, and what are the advantages of each?
5. If Mr. H has acute coronary syndrome, what ECG changes are expected?

Answer 1

• Mr. K 's history includes the smoking habit, over weight and abnormal lipid levels - all these three are predisposing factors of atherosclerosis.
• Pathophysiology

smoking may damage the vessels, increased chance of clog by blood cholesterol, leads to deposition of fat substance in the wall of the blood vessels , further it leads to plaque formation leads to atherosclerosis.

• Complications of atherosclerosis are

Coronary artery disease. while disturbs blood supply to the heart

Carotid artery disease. which can cause a transient ischemic attack (TIA) or stroke.

Peripheral artery disease. This can make less sensitive to heat and cold, increasing risk of burns or frostbite. In rare cases, poor circulation arms or legs can cause tissue death (gangrene).

Aneurysms.

Chronic kidney disease

• Treatment

    Lifestyle changes: These focus on weight management, physical activity, and a healthy diet and quit the smoking.

   Medication: Antiplatelet medications statins, might be prescribed to lower cholesterol, and angiotensin- converting enzyme (ACE) inhibitors can help lower blood pressure.

Surgery: Angioplasty, bypass surgery, thrombolytic therapy.

Diagnostic tests for myocardial Infarction

1. Clinical history of ischaemic type chest pain radiating to arms and back, palpitation, sweating
2. Changes in serial ECG tracings- An ECG is a simple, painless test that detects and records the heart's electrical activity.
3. Rise of serum cardiac biomarkers such as creatine kinase-MB fraction and troponin -CPK Creatine Phosphokinase - Begin to rise 3 to 12 hours after acute MI. Peak in 24 hours ,Return to normal in 2 to 3 days Troponin -Myocardial muscle protein released into circulation after injury. These are highly specific indicators of MI. Troponin rises quickly like CK but will continue to stay elevated for 2 weeks. Myoglobin-lacks cardiac specificity.
4. Confirmatory test is Angiography- This test often is done during a heart attack to help find blockages in the coronary arteries.

ECG changes in Acute coronary syndrome is

1. STEMI : ST segment elevations ,T wave changes Q wave development , Enzyme elevations
2. NSTEMI ST segment depressions ,T wave changes, No Q wave development , Mild enzyme elevations.