PATHO KNOWLEDGE CHECK
MODULE 2
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am
having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents
...
PATHO KNOWLEDGE CHECK
MODULE 2
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am
having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency
Department with a chief complaint of chest pain that radiates down his left arm. He states
that he started having pain several hours ago and says the pain “it feels like an elephant is
sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse.
He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness.
He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped
the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low
Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein
(VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
1 of 2 Questions:
Why is HDL considered the “good” cholesterol?
Selected
Answer:
Coronary heart disease is the leading killer of Americans. It is caused by atherosclerosis, which is
the narrowing of the coronary arteries due to formation of lipid laden lesions. The narrowed
arteries hinders blood flow and can result in destruction of the heart tissue due to inadequate
supply of oxygen, a myocardial infarction. High density lipoproteins (HDL) is considered the
good cholesterol because it does many things to keep the body functioning normally. HDL moves
excess cholesterol from tissues and returns it to the liver. There it binds to liver receptors and is
eliminated from the body as bile or it is converted to cholesterol containing steroids. HDL can
remove excess cholesterol from arterial walls, protect LDL from oxidation, preserve endothelial
function, promotes antiinflammatory and antithrombotic effects. HDL progresses into 3 subtypes,
and the smaller HDL3 molecule is is the most protective in preventing atherosclerosis. If the levels
of HDL are low, they are a strong indicator of coronary risk. Positive family history is a risk factor
of heart disease.
Correct
Answer: HDL is considered the good cholesterol because it collects excess cholesterol
in the body cells and transports it to the liver where it is excreted in the body
cells and transports it to the liver where it is excreted in the body. HDL carries
20-25% of total plasma cholesterol.
Response
Feedback:
[None Given]
Question 2
3 out of 3 points
CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I
am having a heart attack.”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the
Emergency Department with a chief complaint of chest pain that radiates down his
left arm. He states that he started having pain several hours ago and says the pain
“it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing
has made the pain better or worse. He denies any previous episode of chest pain.
Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine
tablet sublingual x 1 which decreased, but not stopped the pain.
Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31
mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very LowDensity Lipoprotein (VLDL) 54 mg/dl
His diagnosis is an acute inferior wall myocardial infarction.
2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.
Selected
Answer:
Atherosclerosis is thickening and hardening of the vessel are caused by the accumulation
of macrophages containing lipids within the arterial wall, which lead to the formation of
plaque. Atherosclerosis ia a pathologic process that can affect vascular systems
throughout the body. It is a chronic inflammatory condition that results from many
processes that damage arterial walls. Endothelial cells that line artery walls are injured.
Injury could be due to aging, smoking, hypertention, and diabetes. The injured
endothelial cells become inflamed and can no longer make adequate amounts of
antithrombic and vasodilating cytokines. Inflammation and oxidized LDL cause
endothelial cells to express adhesion molecules that bind monocytes and other
inflammatory and immune cells. These monocytes penetrate the vessel walls and become
macrophages, called foam cells. When foam cell accumulate in large amounts, they form
a lesion called a fatty streak and cause the release of inflammatory cytokines that injure
the vessel walls even more. Growth factors are released which stimulate smooth muscle
cell proliferation in the affected vessel. The smooth muscle cells produce collagen and
migrate over the fatty streak forming a fibrous plaque.
Correct
Answer: Inflammation in the heart muscle caused by chronic inflammatory
processes leads to mitochondrial damage that results in an increased
free radical production that further activates the chronic inflammatory
vicious cycle.
Response
Feedback:
[None Given]
Question 3
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