Answer KEY - heart disease PDF

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Heart disease case study...

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ANSWER KEY for "A Healthy Retirement?" by Ann Henninger Biology Department Wartburg College, Waverly, Iowa The level of answers provided is for an introductory non-majors human biology course. More indepth explanations would be expected in an upper-level course.

PART I 1. Assess the health of Jim and Nancy by listing the healthy and not-so-healthy things we know about each of them. Fill out a table similar to the one below to list your observations about their health status. As the healthy and not-so-healthy factors are presented, discuss how they help or hinder health. The following table shows factors in bold and how they help or hinder health. The depth of discussion will depend on how the case study is used.

JIM

NANCY NOT-SOHEALTHY

HEALTHY

Aspirin/day— prevents platelets from becoming "sticky" and forming a clot

Smoker— increases risk for a variety of circulatory (hypertension, heart attack, stroke) and respiratory (emphysema, lung cancer) diseases

Swims—aerobic exercise decreases risk of circulatory diseases. She should swim at least 30 minutes three times a week. This kind of non-weight-bearing exercise does not help build strong bones.

Takes medication to control blood pressure— decreases risk for heart attack and stroke

Overweight— increases risk for circulatory diseases and diabetes mellitus type 2; a major

Lifts weights— strength training decreases risk of osteoporosis. Exercise such as lifting weights, walking, running,

HEALTHY Married— married men live longer than unmarried men

NOT-SOHEALTHY Overweight— increases risk for circulatory diseases and diabetes mellitus type 2; a major health risk among U.S. adults and children Family history of osteoporosis— increases risk of osteoporosis Elevated blood glucose—may

Gardening—one of the most frequent forms of exercise used by U.S. adults; can include aerobic and strength benefits if strenuous

health risk among U.S. adults and children

doing jumping jacks stresses the bones and helps to keep them strong, thus preventing osteoporosis.

indicate diabetes mellitus type 2

Slightly elevated lipid levels (total cholesterol, LDL, Gardening—one of TG)—increases the most frequent risk of circulatory forms of exercise used problems such as by U.S. adults; can atherosclerosis, include aerobic and heart attack, and strength benefits if stroke Previous heart attack—increases strenuous Blood pressure risk for another HRT—although heart attack slightly elevated estrogen + —increases risk progesterone HRT has for heart attack, 68 years old— shown an increased aging increases stroke, and kidney risk of heart attack, one's risk for a problems variety of diseases estrogen alone is still being studied. HRT Lives with a smoker (especially decreases the risk of No evidence of bad in combination osteoporosis. regular exercise other than with HRT)— gardening— passive smoking Married—although increases the risk marriage seems to help increases the risk for a variety of of circulatory men more than circulatory (hypertension, women, it does (hypertension, heart attack, increase the life heart attack, expectancy of women. stroke) and stroke) diseases respiratory (emphysema, lung cancer) diseases Stress (getting ready for Stress (mother vacation)— died recently, just increases the risk retired, getting for heart attack ready for vacation) and stroke; lowers —increases the the immune risk for heart response attack and stroke; lowers the immune Too much response alcohol?— increases the risk of cirrhosis of the Too much alcohol?— liver High blood pressure— increases risk for heart attack, stroke, and kidney problems

increases the risk of cirrhosis of the liver A common unit of measure for the plasma or blood concentration of substances is mg/dL or milligrams per deciliter. A milligram is 1/1000 of a gram, and a deciliter is 100 ml or 1/10 of a liter. 2. What diseases are Jim and Nancy at risk for and why?

JIM

NANCY

Coronary heart disease leading to a heart attack—risks include: medical history, overweight, smoker, male, 68 years old, lack of exercise

Coronary heart disease leading to a heart attack—risks include: overweight; secondhand smoke; HRT; slightly elevated blood pressure; elevated total cholesterol, LDL, and triglycerides

Stroke—same risks as for heart attack

Stroke—same risks as for heart attack

Lung cancer—smoker

Lung cancer—second-hand smoke

Emphysema—smoker

Emphysema—second-hand smoke Osteoporosis—family history; passive smoke

Diabetes mellitus type 2— overweight

Diabetes mellitus type 2—overweight, elevated blood glucose

3. What other information would be helpful to know in assessing their health? How would this information help?

JIM

NANCY

More about family medical history

More about family medical history

Blood glucose levels to check for diabetes mellitus, especially since he's overweight

Follow-up test on blood glucose levels to check for diabetes mellitus

Blood lipid levels to help assess his risk for another heart attack or a stroke

Bone density test to check for osteoporosis. She has a family history of this and complains of back pain.

What is her daily calcium intake? She Blood pressure reading. He's taking medication, but we don't know how well needs 1500 mg/day to help lessen her risk of osteoporosis. controlled his blood pressure is.

Hematocrit and RBC count to check for anemia since she's so tired Has he really tried to quit smoking? If so, what techniques did he use? Maybe it's time to talk with the doctor about using a nicotine patch.

Has she tried to reduce her lipid levels by changing her diet? If not, she should be instructed to do so. If she has tried but has been unsuccessful, maybe it's time to try statins (drugs) to lower lipid levels.

When was his last PSA test and digital prostate exam? What did they indicate? Prostate cancer is the most frequently diagnosed cancer in men.

When was her last mammogram? What did it indicate? Breast cancer is the most frequently diagnosed cancer in women.

When was his last test for blood in the stool? His last colonscopy or sigmoidoscopy? What did these tests indicate? Colorectal cancer is the third leading cause of cancer deaths in men.

When was her last test for blood in the stool? Her last colonscopy or sigmoidoscopy? What did these tests indicate? Colorectal cancer is the third leading cause of cancer deaths in women.

PART II 1. How are angina equivalent symptoms different from classic angina symptoms? Women often have "atypical" or "angina equivalent symptoms," which include: unusual fatigue; new, unusual shortness of breath during everyday activities (or at rest); nausea; dizziness; lower chest discomfort; back pain; upper abdominal pressure or discomfort. The "classic" angina symptoms include: pressure, fullness, squeezing pain in the center of the chest, spreading to the neck, shoulder, or jaw; chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath. 2. What causes these symptoms? Angina or angina pectoris ("chest pain") occurs when the supply of oxygen and nutrients to the heart muscle does not keep up with the demand. This usually indicates at least partial blockage of coronary arteries, which may be caused by atherosclerosis. Angina often occurs when one is active but may even occur during rest. The heart doesn't feel pain, but other areas of the body do; this is called referred pain. 3. Why do the symptoms lessen when Nancy rests? When a person experiencing angina rests, the work of the heart decreases. This lessens the need for oxygen and nutrients by the heart muscle. Eventually the referred pain diminishes and may disappear completely as the oxygen supply becomes greater than the demand.

Some individuals take nitroglycerine when they feel angina symptoms. This medication helps to decrease the work of the heart (oxygen demand) and increase coronary blood flow (oxygen supply). 4. Before reading this case study did you know that males and females often have different symptoms for coronary heart disease or a heart attack? If so, how did you find out? Student answers to this question will vary. This question invites a discussion about ways we learn about health issues, assumptions made by the "giver" and "receiver" of the information, and the importance of providing/receiving up-to-date, accurate information. 5. How do medical researchers find out if individuals of both sexes and from diverse racial and ethnic backgrounds have similar symptoms or react the same to treatment? Historically, medical research was performed on white males, often on medical students. They were viewed as the "generic human being." More recently federal funding agencies have required the inclusion of women and people of color in clinical studies. Not only must the subjects represent diverse groups affected by the disease, drug, etc., but also the data collected must be analyzed so that differences can be determined, if they are present. The following is excerpted from "NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research— Amended, October, 2001." ... this notice provides additional guidance on reporting analyses of sex/gender and racial/ethnic differences in intervention effects for NIH-defined Phase III clinical trials. The guidelines ensure that all NIH-funded clinical research will be carried out in a manner sufficient to elicit information about individuals of both sexes/genders and diverse racial and ethnic groups and, particularly in NIH-defined Phase III clinical trials, to examine differential effects on such groups. Since a primary aim of research is to provide scientific evidence leading to a change in health policy or standard of care, it is imperative to determine whether the intervention or therapy being studied affects women or men or members of minority groups and their subpopulations differently. http://grants1.nih.gov/grants/funding/women_m in/guidelines_amended_10_2001.htm...