C-Reactive Drug Case Study

Many studies were conducted on coronary artery disease (CAD) because it is the leading cause of mortality and premature disability so studies investigated those at risk of coronary atherosclerosis aiming to provide early treatment (Kolovou et al., 2005), (Akhabue et al., 2014).

CRPS is a hard syndrome to truly diagnose, which is why some doctors provide their patients with a clinical diagnosis based on the “Budapest Clinical Diagnostic Criteria,” other doctors do not follow these criteria and diagnose on a case-by-case basis (Harden et al., 2010). CRPS is generally caused, and diagnosed

|Required: |Heart |The heart and circulatory system | Coronary artery disease (narrowing of the |

carotid artery comes directly from the aortic arch. In the cat, both common carotid arteries branch from the

4. left ventricle 5. superior vena cava 6. inferior vena cava 7. ascending aorta 8. aortic arch 9. brachiocephalic artery 10. left common carotid artery 11. left subclavian artery 12. pulmonary trunk 13. right pulmonary artery 14. left pulmonary artery 15. ligamentum arteriosum 16. right pulmonary veins 17. left pulmonary veins 18. right coronary artery 19. anterior cardiac vein t s w x v 20. left coronary artery 21. circumflex artery 22. anterior

One of the complications of an acute MI is Left Ventricular Aneurysm (LVA) which is a localized area of myocardium with abnormal outward bulging and deformation during systole and diastole. The epidemiology occurs in 10-30% of patients after an acute MI (American Heart Association 2015). The risk factors include total occlusion of the LAD artery, females and an anterior MI. To prevent this, early revascularization is needed. The LVAs usually range from 1-8 cm.

For this myocardial infarction, the right coronary artery was blocked. The parts of the heart that were affected by this blockage was the right atrium, the right ventricle, the interventricular septum, the Sinoatrial node and the AV node, and some parts of the left atrium and ventricle. These parts were affected because the right coronary artery supplies blood to these parts of the heart; since there was a blockage the blood was not able to continue through the right coronary arteries into its branches, which are the sinoatrial nodal artery, the right marginal branch, the posterior interventricular branch, and the atrioventricular nodal artery (Gest).

Individuals are more likely to develop CVD if they have high blood pressure, high cholesterol, are obese, use tobacco, eat a poor diet, or are not physically active. Most clinical risk factors that contribute to cardiovascular disease can be modified by practicing healthy lifestyle and behavior choices (Yu, Rimm, Lu, Rexrode, Albert, Qi, Willet, Hu, & Manson 2016).

A further multivariate regression analysis revealed that the lowest tertile of serum P1NP concentration (≤29.3µg/L) was found to be significantly associated with nursing home residence (P-value 0.034) after adjustment for age, gender and presence of hypertension; and also to be inversely associated with ALP (P-value 0.000), OC (P-value 0.000) and β-CTX (P-value 0.001) after adjustment for age, gender, ALP, OC, and β-CTX.

Over the past years, heart disease has constituted one of the leading causes death in America. In fact, statistics show that one in every seven deaths is as a result of heart-related diseases (American Heart Association, 2016). Conversely, most deaths reported are of elderly individuals aged above the 65 years. However, there are also other underlying conditions that elevate the risk of developing heart diseases. According to the American Heart Association (2016) 62% of men and 67.8% of women have high blood pressure that are aged between 65-74 years of age. High blood pressure exposes older people to high-risk chances of developing cardiovascular diseases, characterized by high rates of mortality, morbidity, and disability. Cardiovascular

LDL deposits cholesterol in the arteries which cause plaque that restrict blood flow and increase the risk of a heart attack. (Timberlake, 2014, pg. 535)

Angina is associated with clinical events that can affect prognosis, for example Von Arnim et al

These two left arteries feed the front and left side of the heart. The division of the left coronary artery is the reason why doctors usually refer to three main coronary arteries.

Many of the vaso-protective function of endothelium is provide by the Nitric Oxide(NO)20.Endothelium damaged by turbulent or non-laminar blood causes decreased production of NO.Such kind of blood flow also stimulates endothelial cells to produce adhesion molecules, which recruit and bind inflammatory cells. Hypercholesterolemia seems to inactivate the normal function of NO. The net effect is endothelial binding of monocytes and T cells, migration of these cells to the subendothelial space, and initiation of a local vascular inflammatory response. Lipids in the blood, particularly low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL), also bind to endothelial cells. 18Firstly LDL is transported across the healthy intima and become trapped in intima of a vessel wall.It undergoes oxidative modification and then oxidized LDL(OxLDL) is formed5.OxLDL is mighty inducer of inflammatory molecules.It adds up to the inflamotory signaling by endothelium that activates chemotactic substances, growth factors that attracts monocytes to vessel wall21Eventually OxLDL transforms monocytes into macrophages which makes the Forms cells, which are the hallmark of atherosclerosis. Oxidized LDL impair the signal transduction between endothelial cell surface receptors and NO production, inhibit NO synthase activity and inactivates NO realese from endothelial cells.22.Once the endothelium is impaired, oxidized LDL is stored in vascular endothelium and by the process of series of mechanism, foam cells are formed and then eventually fatty plaque that occludes the vessel along with the decreased amount of NO which decreases the ability of the vessel to dilate. As the plaque grows arterial wall narrowing and thickening occurs5. This plaque and narrowing of vessel results in decreased blood flow

Approximately one in every three adult’s ages 20 years old and older are diagnosed with high blood pressure or hypertension. Hypertension affects 78 million people in the United States and is equally prevalent in both men and woman (Crabtree et al., 2013). Hypertension is a major risk factor for cardiovascular disease (Hajjar & Kotchen, 2003). It can lead to stroke, myocardial infarction, renal failure, heart failure, neurological issues, and death if not detected early and not treated properly (James, Oparil, Carter, & et al., 2014). Approximately 9.4 million deaths in 2010 were attributed to high blood pressure (Angell, De Cock, & Frieden, 2015). About 54% of strokes, 47% of coronary heart disease, and 25 % of other cardiovascular diseases are attributed to high blood pressure (Arima, Barzi, & Chalmers, 2011).