Disorders of Blood Flow and Blood Pressure Regulation

Disorders of Blood Flow and Blood Pressure Regulation

Case Study Questions

Question One: Risk Factors for Deborah’s Coronary Heart Disease

Her risk factors include chronic smoking, where she smokes half a pack of cigarettes daily. Being overweight is another risk factor. Moreover, age is a risk factor. People older than 40 years are at a higher risk of heart disease (Malakar et al., 2019). Hence, Deborah is at her post-menopausal age of 56 and at risk of the disease. Dyslipidaemia due to elevated cholesterol levels predisposes individuals to heart diseases (Shaya et al., 2021). Deborah’s cholesterol levels for LDLs are elevated at 180 mg/dL, decreased HDL levels at 36 mg/dL, and her cholesterol total level is beyond the usual threshold with a threshold of 239 mg/dL; hence, she is at a higher risk of the disease. A family history of cardiac-related disease is another factor (Malakar et al., 2019). Her father passed away from acute myocardial infarction. Hence, she is at a higher risk of heart disease. Lastly, her sedentary lifestyle with no physical exercise can predispose her to the disease.

Question Two: The Role of Diet Modification in Controlling the Lipids

A person is most likely to stop plague production or worsening of atherosclerosis by changing their eating habits from atherogenic foods to a healthy and balanced diet that encourages the upsurge of HDLs and reduction of cholesterol and LDLs. Deborah’s LDL levels of 180 mg/dL, a total cholesterol value of 239 mg/dL, and HDL values of 36 mg/dL all fall outside the average limits, which might lead to heart diseases; therefore, dietary changes are required to regulate and control these concentrations. Nutritional changes must be implemented if HDL levels of 36 mg/DL are to elevate to values of 60 mg/DL or above, LDLs must decrease to values lower than 100 mg/dL, and her total cholesterol levels of 239 mg/dL must decrease to values between 120 mg/dL and 200 mg/dL.

De Backer et al. (2019) recommend taking between five to eight portions of fruits and vegetables daily, consuming plant-based proteins and legumes daily, and doing daily physical exercise. Fruits and vegetables lower saturated fats and enhance unsaturated fats, lowering LDL and raising HDL levels. Foods laden with saturated fats, mainly when ingested in excess, lower HDL levels and increase blood cholesterol. Blood LDL levels rise as a result of hypercholesterolemia (Shaya et al., 2021). Reduction of polyunsaturated fats consumption, saturated fats, and non-essential fatty acids by using oils that include monounsaturated fats and essential fatty acids, including olive and sunflower oils, is vital to managing lipid profiles (De Backer et al. 2019). By ingesting fewer trans fats, fewer fried foods, and more dietary fiber, HDL levels can be increased.

The predisposing factors for Deborah can be controlled by restricting her nutritional intake of fat; if Deborah reduces her cholesterol and LDL levels, she will be able to halt atherosclerosis progression and reduce her chance of suffering a heart attack. Deborah needs to alter her diet in order to reduce her LDL and cholesterol and increase her HDL levels by consuming more proteins, whole grains, vegetables, and fruits. She must also avoid sugar, trans fats, and saturated fats.

Question Three: Smoking and the Formation of Atherosclerosis Plaque

Smoking is believed to aid in the development of atherosclerotic plaque by vasoconstricting the blood vessels and accelerating oxidation reactions in the vascular lumen, which in turn destroys the endothelium, which makes it easier for calcium and cholesterol to accumulate and lead to atherosclerotic plaque. These accumulated reactions cause an inflammatory response to the vessels’ lining and plaque production across the vascular system, called atherosclerosis. (Malakar et al., 2019) Smoking has also been found to amplify endothelium dysfunction if it already exists in a susceptible person. Moreover, smoking lowers the HDL levels in the blood, which might lead to atherosclerotic plaque formation. The progression of coronary heart disease, atherosclerosis, and increased concentrations of HDLs are adversely correlated.

Effects of Exercise on Deborah’s Lipid Profile

Deborah’s lipid profile would benefit from exercise because it raises her good cholesterol and HDL levels. Additionally, the bad cholesterols, LDLs, are reduced by exercise. Exercise aids the body in producing and transporting more HDL. An elevation in HDL lowers blood cholesterol concentrations by eliminating cholesterol and LDL levels in the arteries and shifting them towards the liver for excretion (Shaya et al., 2021). It reduces atherosclerosis risk, heart conditions, or heart attacks. Exercise also improves collateral blood flow, which gives the cardiovascular system a healthier reserve in case something was to happen. Physical inactivity and being overweight are major lifestyle factors that raise cholesterol and tend to go in tandem. Therefore, exercise helps reduce weight, which in turn raises HDL.

Question Four: Role of Macrophages in Atherosclerosis Plaques Formation

Since atherosclerosis is a long-term inflammatory condition of the vascular system that is consequently caused by cholesterol build-up in the artery wall, we can understand the reasons for the immune system activated by the artery walls when Deborah has abnormally elevated cholesterol numbers. Macrophage and monocyte inflammatory cells are released as a result of the inflammatory response (Malakar et al., 2019). When monocytes enter the subendothelial area of blood vessels, they transform into macrophages. Macrophages are examples of white blood cells that aid in the removal of debris and the defense against infection. When activated, macrophages produce free radicals that lead to LDL oxidization (Shaya et al., 2021). The endothelial membrane is eventually destroyed by LDL oxidization. Furthermore, macrophages feed the oxidized LDL and create foam cells, which are a feature of all atherosclerotic changes. Finally, macrophages promote the development of smooth muscle and the build-up of cell membranes at the location of the inflammation.

In atherogenic response, the macrophages are engaged in a variety of functions. Macrophages assist in clearing artery plaque during atherosclerosis. Macrophages can aid in lowering the likelihood of coronary disorders by removing plaque. A plaque is an adhesive compound consisting of calcium, fats, and cholesterol (Malakar et al., 2019). It can accumulate in the arteries, causing them to constrict and increasing the risk of stroke or heart attack. It is believed that macrophages help with tissue regeneration and the reduction of inflammation, which are essential in developing atherosclerotic plaque.

Role of Elevated Serum hs-CRP in People at Risk

High hs-CRP levels indicate systemic inflammation, a cofactor released in the inflammatory response’s acute phase. It is a general indicator of inflammation and infection. It has been discovered that comparatively elevated levels of hs-CRP in healthy people are indicators of a higher likelihood of future cardiac arrest, stroke, unexpected cardiac death, or peripheral artery disease (Zhuang et al., 2019). This applies even to those with normal cholesterol levels, which Deborah does not have.

References

De Backer, G., Jankowski, P., Kotseva, K., Mirrakhimov, E., Reiner, Ž., Ryden, L., & Kholef, E. F. (2019). Management of dyslipidemia in patients with coronary heart disease: results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis, 285, 135-146. https://doi.org/10.1016/j.atherosclerosis.2019.03.014.

Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review of coronary artery disease, its risk factors, and therapeutics. Journal of cellular physiology, 234(10), 16812-16823. https://doi.org/10.1002/jcp.28350.

Shaya, G. E., Leucker, T. M., Jones, S. R., Martin, S. S., & Toth, P. P. (2021). Coronary heart disease risk: low-density lipoprotein and beyond. Trends in cardiovascular medicine. https://doi.org/10.1016/j.tcm.2021.04.002.

Zhuang, Q., Shen, C., Chen, Y., Zhao, X., Wei, P., Sun, J., & Yang, S. (2019). Association of high sensitive C-reactive protein with coronary heart disease: a Mendelian randomization study. BMC Medical Genetics, 20(1), 1-7. https://doi.org/10.1186/s12881-019-0910-z.

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In your discussion, be sure to apply knowledge of the physiologic alterations in bodily systems in response to disease processes.

 Case Study 4: Disorders of Blood Flow and Blood Pressure Regulation

Deborah is 56 years old, smokes half a pack of cigarettes a day, and is overweight. Her friend wants her to come to a local women’s fitness class she attends once a week. She knows Deborah’s dad had died of an acute myocardial infarction when he was 56, and she fears, seeing Deborah’s lifestyle, the same fate awaits her friend. What she did not know was that Deborah had also been to her doctor for her annual physical, where she was told her LDLs were 180 mg/dL, HDLs were 36 mg/dL, and cholesterol was 239 mg/dL.

1. What are Deborah’s known risk factors for coronary heart disease?
2. Deborah’s doctor referred her to a dietician for strict dietary therapy, hoping the intervention would raise her HDL and lower her LDL and cholesterol levels. Why is diet modification necessary to control and moderate the lipids indicated?
3. Deborah’s doctor also gave her pamphlets describing strategies to stop smoking and a list of exercise ideas she might want to try. How is smoking thought to contribute to atherosclerotic plaque formation? Why would exercise have a positive effect on Deborah’s lipid profile?
4. Atherosclerosis is thought to be an inflammatory disorder. What is the role of macrophages in the formation of atherosclerotic plaques? What is the significance of elevated serum hs-CRP levels in at-risk individuals?