Mr. S's Bma Case Study
Case Study # 1
Mr. S is 48-year-old male, who is a sales representative for a large electronics firm who travels quite a lot. He has been defined as a Type A personality. He is 6', 190 lbs. with a blood pressure of 142/88 mmHg. Five years ago he has was diagnosed with Type 2 diabetes. He blames his 2 and half pack a day smoking habit on the stress of his job. Family history reveals his brother had a Myocardial Infarction at the age of 40. His cholesterol level is 250 mg/dl, HDL is 30 mg/dl, LDL is 170mg/dl and TG is 250mg/dl. Mr. S complains of chest pain upon exertion. Case Study # 1
Questions 1. Briefly describe the pathophysiology of CAD (25 pts) 2. Calculate Mr. S's BMI (25pts) 3. Based on all the evidence do you …show more content…
CAD stands for coronary artery disease, which is when the coronary arterial lumen becomes narrowed due to the build up of atherosclerotic plaques. Atherosclerosis develops over several stages:
a. Initial injury to the endothelium that stimulates the immune response and brings macrophages to the site of injury. b. Eventually the macrophages are transformed into foam cells due to the accumulation of large amounts of cholesterol, which came from the oxidized LDL they engulfed. The oxidized LDL further injures the endothelium, attracting even more macrophages, resulting in a vicious cycle of injury followed by immune response. The end result is the formation of a fatty streak, which is the precursor to plaque. c. Platelets are drawn to the injured endothelium where they release growth factors that cause abnormal proliferation of smooth muscle cells within the intima. The smooth muscles cells and macrophages then begin to release collagen and proteins, which are the components that form the fibrous aspect of atherosclerotic plaques. d. When the foam cells rupture and die, they spill their cholesterol debris within the plaque. Over time, the plaque begins to harden, and at this point it is prone to cracks or ulcerations, which leads to the formation of blood clots. It is these clots that can eventually become thromboses or emboli, leading to heart attacks or …show more content…
Stage 1 Hypertension – His BP is 142/88 mmHg, but the optimal BP for a diabetic is <130/80 mmHg j. Type 2 Diabetes k. Smoking l. Type A personality m. Although it isn’t explicitly stated, we can infer that he most likely does not do a lot of physical activity. I say this because he travels a lot with his job, so there is bound to be a great deal of time spent sitting on airplanes, in airports, or behind the wheel of a car. It seems the only risk factor Mr. Smith doesn’t have is obesity (BMI >30) 4. Mr. Smith’s risk factors indicate that he is Very High risk for a coronary incident, so he will need pharmacological intervention in addition to the recommended Lifestyle Modifications I have listed below. n. Quit smoking o. Lose weight – losing 10 pounds will lower his BMI to where it is in the normal zone. Weight loss will also lower his total cholesterol, triglycerides, LDL-c, as well as his blood pressure, and will help manage his diabetes and glucose
Mr. S is 48-year-old male, who is a sales representative for a large electronics firm who travels quite a lot. He has been defined as a Type A personality. He is 6', 190 lbs. with a blood pressure of 142/88 mmHg. Five years ago he has was diagnosed with Type 2 diabetes. He blames his 2 and half pack a day smoking habit on the stress of his job. Family history reveals his brother had a Myocardial Infarction at the age of 40. His cholesterol level is 250 mg/dl, HDL is 30 mg/dl, LDL is 170mg/dl and TG is 250mg/dl. Mr. S complains of chest pain upon exertion. Case Study # 1
Questions 1. Briefly describe the pathophysiology of CAD (25 pts) 2. Calculate Mr. S's BMI (25pts) 3. Based on all the evidence do you …show more content…
CAD stands for coronary artery disease, which is when the coronary arterial lumen becomes narrowed due to the build up of atherosclerotic plaques. Atherosclerosis develops over several stages:
a. Initial injury to the endothelium that stimulates the immune response and brings macrophages to the site of injury. b. Eventually the macrophages are transformed into foam cells due to the accumulation of large amounts of cholesterol, which came from the oxidized LDL they engulfed. The oxidized LDL further injures the endothelium, attracting even more macrophages, resulting in a vicious cycle of injury followed by immune response. The end result is the formation of a fatty streak, which is the precursor to plaque. c. Platelets are drawn to the injured endothelium where they release growth factors that cause abnormal proliferation of smooth muscle cells within the intima. The smooth muscles cells and macrophages then begin to release collagen and proteins, which are the components that form the fibrous aspect of atherosclerotic plaques. d. When the foam cells rupture and die, they spill their cholesterol debris within the plaque. Over time, the plaque begins to harden, and at this point it is prone to cracks or ulcerations, which leads to the formation of blood clots. It is these clots that can eventually become thromboses or emboli, leading to heart attacks or …show more content…
Stage 1 Hypertension – His BP is 142/88 mmHg, but the optimal BP for a diabetic is <130/80 mmHg j. Type 2 Diabetes k. Smoking l. Type A personality m. Although it isn’t explicitly stated, we can infer that he most likely does not do a lot of physical activity. I say this because he travels a lot with his job, so there is bound to be a great deal of time spent sitting on airplanes, in airports, or behind the wheel of a car. It seems the only risk factor Mr. Smith doesn’t have is obesity (BMI >30) 4. Mr. Smith’s risk factors indicate that he is Very High risk for a coronary incident, so he will need pharmacological intervention in addition to the recommended Lifestyle Modifications I have listed below. n. Quit smoking o. Lose weight – losing 10 pounds will lower his BMI to where it is in the normal zone. Weight loss will also lower his total cholesterol, triglycerides, LDL-c, as well as his blood pressure, and will help manage his diabetes and glucose