Question

Case Study: A Middle-Aged Woman with Back Pain A Hard-Hearted Woman?

Read the overview and complete the interactivities that follow. Coronary atherosclerosis is a significant condition for both men and women, but the presenting symptoms for the sexes can be quite different. Risk factors and preventative measures are similar for men and women, but it is an unfortunate fact that the diagnosis is occasionally made late in some women because complaints don’t match what is expected. Olivia has a great smile, and it always endears her to her students. She looks much younger than her 47 years, has two teenage sons, and teaches at a local community college. Recently she has had some difficulty getting up the stairs to her third-floor classroom. Never wanting to take the elevator, she considers the stairs part of her ‘exercise program’. For the past several weeks, however, she’s been out of breath by the second floor and for the last couple days she’s had some discomfort in her back. The discomfort is hard to characterize, but she refers to it as a ‘pulling’ sensation right between her shoulder blades lasting just a few minutes. It’s really not painful, and she has no chest discomfort. There is no cramping of her legs. Still, she’s worried because her father and one uncle died in their fifties of heart disease. Adult onset diabetes runs in Olivia’s family, but she has been tested and her blood sugar is always fine. She has never smoked, her blood pressure is not up, but she is aware she has elevated blood cholesterol. References Case StudyCase Study: A Middle-Aged Woman with Back Pain Strategy Case 2 Olivia's Medical History Read the report and answer all questions. Olivia’s doctor immediately scheduled a cardiac catheterization to visualize her coronary arteries. She had several areas of significant luminal narrowing. What are the risk factors for AS, and why did Olivia develop it so young?   
 Genetics is the most important risk factor. If AS is significantly present in your family tree, then the odds are high that you will develop it also.
   Case series 2

 Gender also plays a major role, men are more prone than woman to develop AS.  Modifiable, and environmental, factors include: smoking, hypertension, obesity and diabetes. The most significant of these may be elevated serum cholesterol that is present in two types. Cholesterol packaged as low-density lipoproteins (LDL) is most strongly associated with severity and early age of onset of AS. High blood levels of high-density lipoprotein cholesterol (HDL), indicates optimal or healthy cholesterol metabolism, and is associated with reduced risk of AS.
When considering the above risk factors it is important to realize that the factors for AS are synergistic (each multiplies the risk of the previous factor) rather than just being additive. That is, things get worse a lot faster with each additional risk added.   

1. Risk factors for AS include?
2. The ‘form’ of blood cholesterol that reflects healthy cholesterol metabolism and is associated with a lowered AS risk is?
3. The statement that the risk factors for AS are synergistic means that?

Answer 1

ANSWER 1 - risk factors for aortic stenosis are-

• Patient related- smoking, obesity, diabetes, chronic renal failure, lipid abnormalities ( given in our patient's history ) , older age ,hypertension , concomitant coronary artery disease(also given in our patient).
• Hemodynamic related - left ventricular systolic dysfunction, hemodialysis, hemodynamic changes during exercise.

Valve related - bicuspid valve, degenerative aortic stenosis , valve calcification and regurgitation.

ANSWER 2- high density lipoprotein ( HDL) is also known as the good cholesterol because it carries cholesterol from other parts of the body back to liver and releases those cholesterol esters into the liver it helps in collecting excess cholesterol throughout the extrahepatic cells and this property is the reason we call it the good cholesterol.

Whereas the low density lipoprotein (LDL) is called as the bad cholesterol because the high level of LDL level leads to build up of cholesterol in your arteries and atherosclerosis.

Answer 3- As discussed above the risk factors for aortic stenosis namely hyperlipidemia hypertension smoking and family history of bicuspid aortic valve all of them increase the further risk for development of aortic stenosis. that means all of them are working in a synergistic way thus increasing the overall risk for AS.