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berfrye berfrye
wrote...
Posts: 44
Rep: 1 0
12 years ago
can anyone answer any part of this .Thanks in advance

A 50-year-old airline pilot complained of severe, intense, precordial, crushing sensation with pain radiating to the left shoulder and down the inside of the left arm, triggered by an off-duty tennis match. The chest discomfort brought on by the exertion was relieved by rest. Emergency room examination resulted in the following information:

Heart rate (HR) 98 b/min
Blood pressure (BP) 160/110 mm Hg
ECG: ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as S-T segment depression and decreased R wave height.
The following day an exercise tolerance test was performed to test the functional response to graded stress. This symptom-limited test gave an ischemic ECG response during exercise, characterized by a downward-sloping S-T segment. Mild exertion resulted in chest pain, which was relieved by sublingual nitroglycerin. Coronary angiography showed lumenal obstruction >70% (88%) in three major coronary vessels, including the left anterior interventricular (descending) coronary artery. Nitroglycerin, beta-blockers, and calcium channel blockers were tried as pharmacologic therapy. Angioplasty, the procedure in which a balloon-tipped catheter is inserted into the partially obstructed vessels, was able to increase coronary flow to near normal values.


1a. What is the term for the chest pain experienced by this individual?


1b. What is the cause of this pain?


2. What is the site of action for each of the pharmacologic drug therapies?


a. Nitroglycerin:

b. Beta-blockers:

c. Calcium channel blockers:




3. Describe the gross anatomy of normal coronary arteries.

4. Describe angioplasty. State the pros and cons of its use.welsh
 
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bio_manbio_man
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12 years ago
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wrote...
Educator
12 years ago
3. Describe the gross anatomy of normal coronary arteries.

Both of these arteries originate from the left side of the heart at the beginning (root) of the aorta, immediately above the aortic valve. As discussed below, the left coronary artery originates from the left aortic sinus, while the right coronary artery originates from the right aortic sinus.

Variations

Four percent of people have a third, the posterior coronary artery. In rare cases, a person will have one coronary artery that runs around the root of the aorta. Occasionally, a coronary artery will exist as a double structure (i.e. there are two arteries, parallel to each other, where ordinarily there would be one).

Coronary artery dominance

The artery that supplies the posterior descending artery (PDA) (a.k.a. posterior interventricular artery) determines the coronary dominance.

  • If the posterior descending artery (PDA) (a.k.a. posterior interventricular artery) is supplied by the right coronary artery (RCA), then the coronary circulation can be classified as "right-dominant".
  • If the posterior descending artery (PDA) is supplied by the circumflex artery (CX), a branch of the left artery, then the coronary circulation can be classified as "left-dominant".
  • If the posterior descending artery (PDA) is supplied by both the right coronary artery (RCA) and the circumflex artery, then the coronary circulation can be classified as "co-dominant".

Approximately 70% of the general population are right-dominant, 20% are co-dominant, and 10% are left-dominant. A precise anatomic definition of dominance would be the artery which gives off supply to the AV node i.e. the AV nodal artery. Most of the times this is the right coronary artery.
berfrye Author
wrote...
12 years ago
you rock dude ! thanks
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