Atherosclerotic Case Study

Cardiovascular diseases has affected large number of population worldwide and in developed countries it is responsible for half of all deaths, coronary artery disease (CAD) alone is responsible for 1 of every 4.7 deaths in the United States (Eichner et al., 2002).

The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.

Coronary artery disease remains number one killer of the western civilization despite 40 years of aggressive drug and surgical interventions (Esselstyn). Usually, pharmaceutical drugs, such as statin, are given to try to slow the progression, but may provide uncomfortable side effects. In fact, the majority of patients discontinue statins within 1 year of treatment initiation (Maningat). Furthermore, surgery is performed to circumvent clogged arteries and literally bypass the symptoms. In the last year, 500,000 coronary bypass procedures were performed (Swaminathan et al). However, these surgeries can have significant risks, including the potential to cause further heart damage, stroke, and brain dysfunction. Thus, it is evident that these way of treatments may not be enough on its own, and that getting to the

Currently, Heart disease is the leading cause of death among women in the United States (Haskell et al., 2014). In the 2016 Update of the Heart Disease and Stroke Statistics report from the American Heart Association, women, in general, have a 32% prevalence rate for LDL issues vs. 31% for men. Likewise, in older women vs older men, the prevalence for hypertension rates for women were 57% vs. 54% in men (Mozaffarian et al., 2016). Within the VA, there is an even bigger gap for management of LDL’s and heart disease. 79.47% of women vs. 88.89% of men have LDL levels within the normal limits. Similarly, 79.34% of women vs. 85.67% of men with diabetes had an LDL within normal limits (Whitehead et al., 2014). Both high LDL and hypertension are proven risk factors for heart disease and stroke. When paired with diabetes, risk of peripheral artery disease, heart failure, and irregular heartbeat can also be factors (Mozaffarian et al., 2016).

The patient described in this paper will be referred to as Jonathan Toews to ensure patients confidentiality. Jonathan Toews, is a sixty three year old man, born on August 23rd 1956, and lives with his eldest son. He was married two times and has three children, two children from his first marriage and one from his second. He lives in northern Ontario but originally was not born here, he moved here shortly following his second divorce. He is of Italian decent and is a practicing catholic. The patient weights 95kgs, is 178cm tall and has a body mas index (BMI) of 28.3. He said he used to play soccer when he was younger but since does not keep active or get the recommended amount of daily activity. Jonathan says he smokes around one pack or cigarettes a day and has a alcoholic drink roughly three to four drinks per week, he also describes that he eats fast food a few times a week. The patient now has congestive heart failure as a consequence of his MI. He was transferred from another hospital at the beginning of November and currently is waiting for more testing before he can be discharged from the hospital or moved to another facility. The patient has some known comorbidities that can exacerbate his CHF, this includes smoking, obesity, and noncompliance with medications.

Mr. Hightower is a 52 year old male with a PMH Type 2 DM, Hyperlipidemia, and HTN. He is a new patient to your office stating he stopped his meds several months ago and he cannot remember what he took in the past. His BP is 150/90. HR 88, RR 20 BMI 35. HGB A1C is 9.6, Total chol 225, LDLs 183, HDL 35. CBC, CHem, LFTs are wnl except for glucose of 124. Discuss the focused pertinent physical exam for this patient as well as what further diagnostics are needed in providing evidenced based care. What medications are important to start for this patient to treat his co-morbidities. Include the follow-up for this gentleman along with pertinent diagnostics needed at

Heart disease is a complication associated with diabetes. When it comes to procedures such as bypass, surgery, angioplasty and stents, it is usually presumed that the least invasion option is the best. Discover the truth behind this presumption and why it might not always be the case for those with diabetes.

Type-2 Diabetes mellitus (T2DM) is a common disease worldwide. According to the American Diabetes association (ADA), 1808 million people in the United States have been diagnosed with diabetes, and another 7 million are thought to have the disease but have not been diagnosed. (Hilaire, Woods, 2013). This disease has impacted everyone in some way. It is a controllable disease; however many individuals choose not to control it or are uneducated on how to control it. Many people with type 2 diabetes (T2DM) also have hypertension, high cholesterol, obesity, lack of physical activity, poorly controlled blood sugars, and smoking. “Current evidence supports the concept that hyperglycemia significantly contributes to the development of both cardiovascular and microvascular complications of T2DM” (Chittari, McTernan, 2011). Cardiovascular disease (CVD) remains the leading cause of death in patients with diabetes mellitus, accounting for 50% of all deaths (Campbell & Hillman, 2010).

Among U.S. adults aged 20 years or older with diagnosed diabetes, the estimated crude prevalence of

Diabetes also increases the risk of PAD by causing dysfunction of the smooth muscle and endothelium of the arteries. The risk of developing PAD is positively correlated with the duration and severity of the patient’s diabetes. Dyslipidemia accelerates the progression of PAD, and hypertension can increase the incidence of intermittent claudication.1

At the formation of the NHPAs, CVD was the leading cause of mortality and morbidity in Australia, responsible for 53,791 deaths in 1996 and 21.9% of disability adjusted life years (DALYs) (Mathers et al., 1999). This burden is dominated by coronary/ischaemic heart disease (CHD), accounting solely for 57% of the DALYs for CVD. Ischaemic heart disease alone had a financial healthcare encumbrance of $894 million in 1993-94 (Mathers et al., 1999) . The significance of CHD is so fundamental that the NHPA publication stated as its primary goal, “Improve cardiovascular health by reducing coronary heart disease and its impact on the population”(DHFS, 1997). CHD is a result of a manifestation of plague and arterial build-up as a complication of atherosclerosis, and can lead to an acute myocardial infarction (AMI) or present with ongoing chest pain known as angina. There has been a significant and unambiguous rise in the mortality rate and incidence of ischemic heart disease in middle-aged white males since the beginning of the twentieth century (Anderson, 1973). The DALYs comparison between males and females for specific aged groups can be seen in figure 1 below (DHFS, 1997). Whilst the definition of ‘middle age’ generally encompasses the 45-64 age bracket, the figure below can still be used to ascertain a perception of the relative differences between

Atherosclerosis is a type of arteriosclerosis. Arteriosclerosis is a general term for the thickening and hardening of arteries. Atherosclerosis, or hardening of the arteries, is a pathological situation in which plaque builds up inside the arteries. Plaque is usually made of cholesterol, fatty substances, cellular products, calcium and fibrin (a clotting material in the blood). Atherosclerosis is the leading cause of mortality and morbidity from cardiovascular disease (CVD) around the world. The magnitude of this problem is so high that atherosclerosis claims more lives than all types of cancer combined and the financial burden are considerable1. It a complex, chronic pathological

Peripheral vascular disease is divided into subcategories of functional and organic. “Functional PVD does not involve physical problems in the blood vessels. It causes incidental or short-term symptoms. These are usually spasms that occur erratically. Organic PVD involves changes in blood vessel structure. This type of PVD causes inflammation, tissue damage, and blockages” (Giorgi 2015). The number one leading cause of peripheral vascular disease is atherosclerosis. “This is a gradual process in which a fatty material builds up inside the arteries” (emedicinehealth 2015). Other contributing factors to PVD include smoking, inactivity, diabetes, obesity, high blood cholesterol, hypertension, emboli from another location, inflammation of blood vessels, injury to blood vessels, and stress. (Giorgi 2015)

As the population ages heart failure is expected to increase exceptionally. About twenty-two percent of men and forty-four percent of women will develop heart failure within six years of having a heart attack. “Thirty years ago patients would have died from their heart attacks!” (Couzens)

Cardiovascular diseases are frequently associated with chronic kidney disease patients on hemodialysis, and it is a major cause of morbidity and mortality in this group of patients. The spectrum of cardiovascular diseases range from arterial vascular diseases to cardiomyopathy. Arterial vascular diseases are prevalent in chronic kidney patients, as it is caused by atherosclerosis and vascular calcification. Accelerated atherosclerosis and vascular calcification are frequent in the medium sized vessels in chronic kidney disease patients.[1] The increase in thickness of the intima-media layers of carotid arteries can be a predictor of coronary atherosclerosis and is also a prognostic factor for cardiovascular accidents.[2][3]