Clinical Cases Atherosclerosis

Clinical Case
Mr. Brown, a 55-year-old male accountant, presents to your clinic with a chief complaint of chest pain. He enjoys walking his dog in the park near his house, but now finds himself having to take frequent breaks to catch his breath and relieve temporary chest pain. He has been a smoker (1 pack/day) since college, and has not visited a doctor in many years. His BP is 160/100, HR 68, RR 18, T 98.8F.

1. What is likely causing Mr. Brown's angina? And what is the likely underlying cause?
   
   
   1. Chronic stable plaque (myocardial ischemia) due to atherosclerotic plaque buildup in a coronary artery.
      
      
2. What risk factors are associated with atherosclerotic plaques?
   
   
   1. Modifiable: smoking, hypertension, hyperlipidemia (LDL is a risk factor, HDL is protective), diabetes mellitus
      
      
   2. Non-modifiable: family history of heart disease, age (increased risk with age), sex (increased risk in males and postmenopausal women-estrogen is protective)
      
      
3. What are complications of atherosclerotic plaques along the great vessels of the body?
   
   
   1. Aneurysms (especially in the aorta), ischemia (especially if the plaque is in the coronary vessels), myocardial infarcts (coronary vessels), thrombi/emboli.
      
      

CONTINUE