Atherosclerosis Case Studies


CASE 1:


Clinical History:

A 66-year-old man had been in fairly good health throughout most of his life, though he had increasing exercise-induced angina for the past 5 years. His total serum cholesterol was 257 mg/dl with an HDL component of 30 mg/dL. His blood pressure was 145/95 mm Hg. The cross sections of coronary artery show occlusive atherosclerosis with thickening of the intima and calcification. Identify the remaining lumen.

  1. What are the consequences for the myocardium from coronary atherosclerosis?

    2. The diminished blood flow leads to ischemia, with possible infarction. Damaged myocardium can heal with areas of fibrosis.

  2. Name risk factors for coronary atherosclerosis.

    3. Factors that are not modifiable are: male sex, increasing age, and familial history. Modifiable risk factors include: hypertension, smoking, hyperlipidemia, and diabetes. His total cholesterol is high and his HDL cholesterol is low, indicating significant risk for atherosclerotic disease. Atherosclerosis and coronary artery disease (CAD) are the commonest sequelae of hypertension. Risk increases in relation to the extent of blood pressure elevation, whether this is a systolic or diastolic elevation, at any age and in either sex. Even isolated systolic hypertension increases cardiovascular risk.

    Less certain risk factors are: obesity, decreased exercise, stress, oral contraceptives.

  3. Is the incidence of coronary artery disease increasing or decreasing in the U.S.?

    4. It is decreasing, primarily due to changes in lifestyle (diet and exercise patterns).