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What is Coronary Artery Disease (CAD)? - ANSWER-CAD is
considered the
leading cause of death in the United States (U.S.). It is
the result of
longstanding
atherosclerosis.
Atherosclerosis begins with damage to the endothelium. It is
the endothelium,
under normal functioning that maintains balance between the
vasoconstrictive
and vasodilation actions, prevents platelets from aggregating
and control of the production of fibrin. When the endothelium
becomes damaged, our familiar inflammatory processes occur.
Macrophages attach to the endothelium, setting up
phagocytosis; plaque formation and vasoconstriction also
occurs marking the beginning of atherosclerosis. The plaque
,lesions located in the vessels become enlarged which allows
the plaque to progress within the enlarged vessel lumen. The
plaque lesion disrupts normal blood flow and causes thrombus
formation which can be triggered by cardiac risk factors such
as elevated LDL, cholesterol, smoking and diabetes.
So, why is this a problem?
Well, the plaque takes decades to develop in the coronary
arteries. With mild disease, blood flow can get through the
arteries and the patient is asymptomatic. Overtime, this build
up can lead to narrowing which results in decreased oxygen
supply. When atherosclerosis reaches a clinically significant
level, the patient will begin to experience angina. Further
progression of the disease will result in acute coronary
syndrome (ACS), formerly known as myocardial infarction (MI).
The major risk factor for the development of CAD - ANSWER-
The major risk factor for the development of CAD is family
history. There is a 50% higher risk for individuals to develop
heart disease if they have a first degree relative (especially
father) or sibling who has suffered from ACS or premature
cardiac death (< age 55 years). Lifestyle also impacts risk,
especially tobacco use and even secondhand smoke exposure.
It is always important for the NP to stress smoking cessation
with all patients who smoke tobacco, in order to decrease the
, patient's risk for CAD. Sedentary lifestyle will also increase
one's risk for developing CAD. Physical inactivity can lead to
overweight (BMI 25-29.9) or obesity (BMI 30 and above). Male
gender, hypertension, Elevated total cholesterol, elevated low-
density lipoprotein (LDL), and/or decreased highdensity
lipoprotein (HDL) are also risk factors, as well as diabetes
mellitus.
a blowing, holosystolic murmur - ANSWER-A patient with
mitral regurgitation
would most likely
present with
Mid-systolic crescendo-decrescendo murmur. - ANSWER-
The patient with
aortic stenosis would most likely
present with:
An early, high-pitched diastolic murmur heard at the left lower
sternal border
A diastolic rumbling murmur heart at the apex of the heart
A systolic crescendo-decrescendo murmur heart at the left
upper sternal border (All of the above) - ANSWER-The patient
with aortic regurgitation would most likely present with: