1. Rashidah is a 55-year-old female who is experiencing acute chest pain and shortness of breath. She describes the pain as “pressure and squeezing.” When she becomes nauseous and light-headed, her son insists that he take her to the emergency room.
Health History: She started smoking when she was 18, attempted to quit several times in her 40s, and had her last cigarette on her 50 th birthday. She has been overweight for most of her adult life, but has gained 20 pounds in the last few years, which increased her BMI to 34. The last time she had a physical exam was when she turned 50. Her vital signs and blood test results from that exam are listed below.
HDL: 62 mg/dl
LDL: 190 mg/dl
Triglycerides: 174 mg/dl
Total cholesterol: 252 mg/dl
Fasting blood glucose: 128 mg/dl
Which of these statements is most likely correct?
Rashidah is experiencing a stroke.
If Rashidah’s symptoms persist even when she rests, she is experiencing angina.
Rashidah is likely experiencing a myocardial infarction.
Since Rashidah’s symptoms are acute, she is likely suffering from a respiratory disorder.
1. In the emergency room, multiple tests are performed. Which of these results would confirm myocardial damage?
Elevated troponin and creatine kinase
Elevated blood glucose levels
Increase in WBC count
1. Which of Rashidah’s physical exam lab test results was within normal limits for her age and sex?
Fasting blood glucose
1. Given her last physical exam results, Rashidah’s physician believes she has likely had undiagnosed atherosclerosis for years. Briefly describe the pathophysiology of atherosclerosis.
1. Rashidah’s most recent Body Mass Index indicates that she is:
1. Which of the following statements is true?
Rashidah’s lab results and history tell us that she has Metabolic Syndrome.
Rashidah’s heart attack was likely caused by a pulmonary embolism.
Rashidah’s heart attack was likely unrelated to her history of smoking.
Rashidah’s risk of a repeat heart attack is very low.
1. A coronary angiography is performed and shows a complete blockage of the LAD. Briefly describe what this means.
1. Which of the following treatments would help correct Rashidah’s condition?
Surgical placement of a stent in the left descending artery
Surgical repair of her aorta
Mitral valve replacement
Vitamin K supplementation
1. Rashidah quit smoking 5 years ago, but still suffered a myocardial infarction. She is tempted to start smoking again since quitting “obviously didn’t make me healthier.” What does research tell us about her future health risks if she resumes smoking?
1. Before Rashidah is discharged from the hospital, her care team informs her that she may experience stable angina, a form of chest pain, in the future. Briefly explain how angina is different from the pain associated with a myocardial infarction.
1. Roberto is a 78-year-old male who has recently been diagnosed with Class III Congestive Heart Failure (CHF). His physician told him that his left ventricle has become stiff and cannot relax. Although there is no current treatment that can “fix” Roberto’s condition, he is prescribed two medications- an ACE inhibitor and beta blockers.
There are multiple types of CHF. Which of these types does Roberto have?
Systolic heart failure
Diastolic heart failure
Right-sided heart failure
None of these choices is correct.
1. Which of these statements is most likely true of Roberto’s current symptoms?
He doesn’t experience any symptoms at all at rest or during exercise.
He has no symptoms at all during rest, but experiences palpitations, fatigues, and shortness of breath during mild exercise.
He experiences fatigue, shortness of breath, and palpitations at rest and is not able to participate in any physical activity.
1. Because of the dysfunction of Roberto’s left ventricle, which of these findings is most likely?
Decreased cardiac output
End-diastolic volume is increased significantly
Decreased diastolic pressure in the left ventricle
Increase in stroke volume
1. Briefly describe how beta-blockers will influence Roberto’s heart function, specifically the physiology of the ventricles.
1. Briefly describe how ACE-inhibitors will influence Roberto’s heart function.
1. Roberto’s doctor orders several tests of his heart function, including “ejection fraction.” Briefly explain what an ejection fraction measures. (Include what a normal measurement would be.)
1. Which of the following conditions may have led to Roberto’s CHF?
Faulty heart valves
Prior heart attacks
All of these choices are correct.
1. Which of the following choices is NOT a risk factor for developing CHF?
History of adrenal disorders
1. Which heart valve opens to allow blood to leave the left ventricle?
1. Further testing reveals that Roberto has hypertrophy of the left ventricle. How does this finding relate to his diagnosis?