Case 1
You are examining a 5-week-old infant and hear a systolic murmur at the lower left sternal border. You suspect a ventricular septal defect. The parents are concerned and have several questions.
Answer the following questions based on this scenario.
- What is the cause of a ventricular septal defect?
- What problems will our baby have due to his VSD?
- How does the defect create these problems?
- What diagnostic tests will be ordered?
- What treatment will our baby need?
Case 2
Mr. Delano comes in to discuss the results of cardiovascular diagnostic tests. He is a 61-year-old White man with no complaints. Past medical history: left hip osteoarthritis and gout; Past surgical history: none; Allergies: none known; Medications: allopurinol 100 mg by mouth once a day; Social history: one to two alcoholic drinks three times a week; smokes one cigar every other month; exercises for 1 hour six times a week; retired nurse—works per diem at hospital once a week; Family history; mother, father, and one bother with hypertension; one brother with dyslipidemia.
Physical exam: vital signs – temperature 98.5°F; pulse 60 beats per minute; respirations 20 per minute; and blood pressure 134/67 mmHg; height 180 cm; weight: 85.5 kg; body mass index 26.3; physical exam unremarkable.
See cardiovascular diagnostics table in the text on page 157. ( Dlugasch, L. & Story, L. (2019). Applied pathophysiology for the advanced practice nurse (1st ed.). Jones & Bartlett. ISBN: 9781284150452
Answer the following questions based on this scenario.
- Which of the cardiovascular diagnostic values demonstrate dyslipidemia and risk for atherogenesis?
- Interpret and describe lipoprotein subfractions and apolipoproteins results.
- Which of the cardiovascular diagnostic values are in the cardioprotective range?
- What lifestyle recommendations, such as diet and exercise will be made based on these results?
- What is his ASCVD risk score? What parameters (e.g., blood pressure) are used to calculate the risk score?
Case 3
Compare the following two (2) scenarios.
Scenario 1: Mr. Fernandez is a 62-year-old man who comes into the clinic complaining of left lower leg swelling that started 5 days ago. He says the leg hurts but mainly when he walks and does not get better after rest. He denies any trauma or fever. He returned from an international trip 2 days before the swelling started. He is healthy except for hypertension, which is well controlled with a daily thiazide diuretic.
Scenario 2: Mr. Kraft is a 65-year-old man who comes in complaining of lower leg pain that he has had for the past 3 months. He says both his legs cramp up in his calves when walking. He sits down to rest and the cramps go away. He denies any trauma or fever. He has smoked 1 pack of cigarettes a day for the past 35 years. He has type 2 diabetes for which takes metformin twice a day.
Answer the following questions based on these two (2) scenarios:
- In which scenario are the history and findings consistent with a venous disorder and which is consistent with an arterial disorder?
- What are the most likely venous and arterial disorder diagnoses?
- Describe the pathogenesis of these venous and arterial disorders.
- What would be expected physical examination findings with a venous disorder and which with an arterial disorder?
- Which diagnostic tests and treatment are indicated for a venous disorder?
- Which diagnostic tests and treatment are indicated for an arterial disorder?
- Professional reflection on the 3 cases and add citations and references.
