NR 507 CARDIOVASCULAR QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

NR 507 CARDIOVASCULAR QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
CardiovascularLdisordersL-
LANSWERLCardiovascularLdisordersLareLprevalentLinLprimaryLcare.LManyLofLtheLdisordersLdevelopLoverLseve

ralLyears,LdueLtoLtheLriskLfactorsLtoLwhichLindividualsLhaveLbeenLexposed.LForLeachLdisorderLcoveredLinLthisL
unit,LaLdiscussionLofLriskLfactorsLwillLbeLincluded.LForLtheLconceptsLcoveredLbelow,LclinicalLapplicationLofLea
chLdiseaseLwillLbeLprovidedLsoLthatLstudentsLcanLunderstandLtheLimportanceLofLpathophysiologyLinLdiagnos
ingLandLtreatingLtheLdisease.



PrerequisiteLknowledge:

ForLthisLcontent,LyouLshouldLhaveLaLbasicLknowledgeLofLcardiacLanatomy;LknowLtheLdifferencesLbetweenLth
eLrightLandLleftLsidesLofLtheLheart,LinLtermsLofLstructureLandLfunction.LYouLshouldLalsoLpossessLsolidLknowle
dgeLofLtheLunidirectionalLbloodLflowLthroughLtheLheart.LForLexample,LdeoxygenatedLbloodLarrivesLtoLtheLrig
htLsideLofLtheLheart,LtravelsLtoLtheLpulmonaryLarteriesLtoLreleaseLCO2LandLpickLupLoxygen.LAtLthisLpoint,LtheL
oxygenatedLbloodLisLcarriedLfromLtheLlungsLthroughLtheLpulmonaryLveinsLtoLtheLleftLsideLofLtheLheartLwher
eLitLeventuallyLreachesLtheLaortaLtoLcarryLoxygenatedLbloodLoutLtoLtheLbodyLorgans.LTheLcellularLphysiology
LrelatedLtoLcardiacLcontractionLisLanotherLimportantLbasicLconceptLtoLknow,LasLelectrolytesL(sodium,Lpotass

iumLandLcalcium)LplayLaLmajorLroleLinLmuscleLcontraction.LFinally,LtheLconceptsLofLpreload,Lafterload,LandLc
ontractilityLareLessentialLtoLunderstand,LasLallLofLtheseLcanLbeLaffectedLinLsomeLwayLwhenLaLpersonLhasLcar
diovascularLdisease.



WhatLisLCoronaryLArteryLDiseaseL(CAD)?L-
LANSWERLCADLisLconsideredLtheLleadingLcauseLofLdeathLinLtheLUnitedLStatesL(U.S.).LItLisLtheLresultLofLlongsta

ndingLatherosclerosis.L



AtherosclerosisLbeginsLwithLdamageLtoLtheLendothelium.LItLisLtheLendothelium,LunderLnormalLfunctioningLt
hatLmaintainsLbalanceLbetweenLtheLvasoconstrictiveLandLvasodilationLactions,LpreventsLplateletsLfromLagg
regatingLandLcontrolLofLtheLproductionLofLfibrin.LWhenLtheLendotheliumLbecomesLdamaged,LourLfamiliarLin
flammatoryLprocessesLoccur.LMacrophagesLattachLtoLtheLendothelium,LsettingLupLphagocytosis;LplaqueLfor
mationLandLvasoconstrictionLalsoLoccursLmarkingLtheLbeginningLofLatherosclerosis.LTheLplaqueLlesionsLloca
tedLinLtheLvesselsLbecomeLenlargedLwhichLallowsLtheLplaqueLtoLprogressLwithinLtheLenlargedLvesselLlumen.
LTheLplaqueLlesionLdisruptsLnormalLbloodLflowLandLcausesLthrombusLformationLwhichLcanLbeLtriggeredLbyLc

ardiacLriskLfactorsLsuchLasLelevatedLLDL,Lcholesterol,LsmokingLandLdiabetes.L



So,LwhyLisLthisLaLproblem?L

Well,LtheLplaqueLtakesLdecadesLtoLdevelopLinLtheLcoronaryLarteries.LWithLmildLdisease,LbloodLflowLcanLgetLt
hroughLtheLarteriesLandLtheLpatientLisLasymptomatic.LOvertime,LthisLbuildLupLcanLleadLtoLnarrowingLwhichL

, resultsLinLdecreasedLoxygenLsupply.LWhenLatherosclerosisLreachesLaLclinicallyLsignificantLlevel,LtheLpatientL
willLbeginLtoLexperienceLangina.LFurtherLprogressionLofLtheLdiseaseLwillLresultLinLacuteLcoronaryLsyndromeL
(ACS),LformerlyLknownLasLmyocardialLinfarctionL(MI).



TheLmajorLriskLfactorLforLtheLdevelopmentLofLCADL-
LANSWERLTheLmajorLriskLfactorLforLtheLdevelopmentLofLCADLisLfamilyLhistory.LThereLisLaL50%LhigherLriskLforLi

ndividualsLtoLdevelopLheartLdiseaseLifLtheyLhaveLaLfirstLdegreeLrelativeL(especiallyLfather)LorLsiblingLwhoLhas
LsufferedLfromLACSLorLprematureLcardiacLdeathL(<LageL55Lyears).LLifestyleLalsoLimpactsLrisk,LespeciallyLtobac

coLuseLandLevenLsecondhandLsmokeLexposure.LItLisLalwaysLimportantLforLtheLNPLtoLstressLsmokingLcessatio
nLwithLallLpatientsLwhoLsmokeLtobacco,LinLorderLtoLdecreaseLtheLpatient'sLriskLforLCAD.LSedentaryLlifestyleL
willLalsoLincreaseLone'sLriskLforLdevelopingLCAD.LPhysicalLinactivityLcanLleadLtoLoverweightL(BMIL25-
29.9)LorLobesityL(BMIL30LandLabove).LMaleLgender,Lhypertension,LElevatedLtotalLcholesterol,LelevatedLlow-
densityLlipoproteinL(LDL),Land/orLdecreasedLhigh-
densityLlipoproteinL(HDL)LareLalsoLriskLfactors,LasLwellLasLdiabetesLmellitus.



MyocardialLischemiaL-
LANSWERLMyocardialLischemiaLisLtheLcauseLofLhisLchestLpain.LIschemiaLoccursLwhenLtheLheart'sLoxygenLde

mandLexceedsLsupply.LForLthisLpatient,LheLexperiencedLhisLchestLpainLduringLexercise.LIschemiaLoccurredLb
ecauseLofLtheLnarrowingLofLatLleastLoneLcoronaryLarteryLbyLatheroscleroticLplaques.LTheLresultLisLtheLnarro
wingLofLtheLdiameterLofLtheLcoronaryLartery.LThisLreducesLoxygenatedLbloodLflowLthroughLtheLarteryLthatLl
eadsLtoLanLinsufficientLoxygenLsupplyLtoLtheLheart.LAdenosineLisLalsoLreleasedLthatLstimulatesLsympatheticL
nerveLfibersLthatLcausesLatrialLandLventricularLcontraction.LInLaddition,LsympatheticLstimulationLoccursLatLt
heLupperLthoracicLdorsalLrootsLofLtheLspinalLcordLthatLleadsLtoLtheLarmLpain.



C.G.LhasLseveralLriskLfactorsLcontributingLtoLtheLdevelopmentLofLCAD:L-LANSWERL1)Lmale

2)LfamilyLhistoryLofLCAD

3)Lhypertension

4)Lsmoking



CADLshouldLstronglyLbeLsuspectedLandLfurtherLtestingLtoLassessLtheLextentLofLtheLpatient'sLdiseaseLincludin
g:L-
LANSWERLElectrocardiogramL(ECG),LcardiacLenzymesL&Ltroponin,Llipids,LandLcardiacLstressLtest.LInLmostLcas

es,LtheLpatientLwillLbeLreferredLtoLandLco-managedLbyLaLcardiologist.LTreatmentLwillLincludeLbothLnon-
pharmacologicalLandLpharmacologicalLmanagementLofLtheLdisease.



HeartLFailureL-
LANSWERLHeartLfailureLisLaLveryLcomplexLdiseaseLstateLthatLcanLbeLtheLresultLofLstructuralLorLfunctionalLimp