Question

2:41 pm Mon 15 Jun Angina case study: A 59 year old man presented with chest pain upon exertion, lasting for 10 minutes, radiating to the upper left limb and accompanied by shortness of breath. An ECG did not indicate myocardial ischemia and blood tests showed myocardial injury markers were not elevated Coronary anpography revealed 90% occlusion of the lower main branch of the left coronary artery with blood flow to the left ventricle maintained by well-developed collateral vessels. A diagnosis of stable angina was made. The patient was previously on daily prescription of simvastatin and captopril. Sublingual glyceryl trinitrate was prescribed for managing future acute angina attacks and the patient was scheduled for coronary arterial by pass surgery. (Questions 1 to 4-1 mark each, Question 5 - 6 marks. Total 10 marks). Q1. The patient was receiving simvastatin to treat: A depression B. heart failure Chypercholesterolemia D. hypertension E. kidney failure Q2. The patient was receiving captopril to treat: A depression B. heart failure C. hypercholesterolemia D. hypertension E kidney failure Q3. Given your answers to Q1 and 2, this patient probably has: A atherosclerotic plaques B. blood vesselmalformations C. deep vein thrombosis D. low blood pressure E schitophrenic episodes Q4. Glyceryl trinitrate is delivered sublingual because of A rapid breakdown in gastric juices B. extensive first-pass metabolism in the liver C. rapid clearance by the kidney D. direct blood flow from the mouth to the heart E poor absorption across epithelial barriers Q5. Describe the rationale behind the use of organic nitrates in treating angina, including their mechanism of action, and why they may be particularly effective in this patient. (6 marks)

Answer 1

1. (B) Heart failure.

Simvastatin is used to lower cholesterol and triglycerides (types of fat) in the blood. Simvastatin is also used to lower the risk of stroke, heart attack, and other heart complications in people with diabetes, coronary heart disease, or other risk factors.Simvastatin  used to prevent certain types of heart problems in patients with risk factors for heart problems.

2. D) Hypertension

Captopril is used alone or in combination with other medications to treat high blood pressure and heart failure. It is also used to improve survival and reduce the risk of heart failure after a heart attack in patients a heart condition called left ventricular hypertrophy (enlargement of the walls of the left side of the heart).

High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

3.A). correct option atheroschlerotic plaques

Although high blood pressure is common, it's not harmless. High blood pressure is a major cause of atherosclerosis, the artery-clogging process that leads to heart attacks and strokes. Blood pressure higher than 130/80 is see

B). incorrect

Arteriovenous malformations

• Overview. Arteriovenous malformations (AVMs) are defects in the blood vessels of the circulatory system. A malformation is an abnormal connection between the veins and arteries. This interferes with your body’s ability to circulate blood. It’s usually congenital, which means the condition is present at birth.

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body

The warning signs and symptoms of a pulmonary embolism include:

Sudden shortness of breath, Chest pain or discomfort that worsens when you take a deep breath or when you cough.

C). option is also incorrect .

This person has serious high blood pressure issue so the D option is incorrect.

Schizophrenia is a mental illness characterized by relapsing episodes of psychosis. Major symptoms include hallucinations, delusions. thus (E) is also incorrect.

4. D). direct blood from mouth to the heart.

  GLYCERYL TRINITRATE SUBLINGUAL Common Brand Name(s): Angised Uses Nitroglycerin relaxes blood vessels allowing more blood to flow through. This reduces the workload on the heart and improves blood flow to the heart. Sublingual nitroglycerin tablets act quickly to relieve chest pain (angina).