New Studies Question Value of Opening Arteries1. (Question from textbook Ch 4 #8) The Framingham Heart Study was a monumental project not only for cardiovascular disease, but for all of science, health, and medicine. Answers to the following questions may be found at the study’s website: http://www.nhlbi.nih.gov/about/framingham/.a. What was the initial purpose of the Framingham study?b. List 5 definite risk factors for cardiovascular disease, and the year in which they were found to be associated with an increased risk.2. You are a cardiac surgeon specializing in heart valve replacement. You have two current patients, an 80 year old man and a 4 year old girl. Available you have two device options: a bioprosthetic pericardium valve and a newly developed tissue engineered heart valve (that is approved for clinical trial use in both patients). What would you recommend to each patient and why? Please provide 2-3 sentences for each clearly explaining your recommendation and the reasoning behind your selection. If you need it, additional information can be found in this review article focusing on heart valve tissue engineering. http://circres.ahajournals.org/cgi/content/full/97/8/743 3. Using textbook chapters 4 and 12 and the information we learned in class regarding cardiovascular diseases and atherosclerosis please give three reasons why prevention of CVD is important in both the developed and developing world.(Question from textbook Ch 12 # 3) An avid runner is out for her morning jog before classes.a. Before she starts her jog she measures her pulse for 15 seconds. She counts about 17 beats in the 15 seconds. What is her Heart Rate in beats per minute?b. This same jogger buys a heart rate monitor because she wants to see her heart rate through different parts of her run. When she is in the middle of her workout the monitorreads her heart rate as 119 bpm. If she were to feel her pulse at this same time for 15 seconds about how many beats would she feel?c. Assuming that her heart Stroke Volume (SV) is about 70 ml, what would her Cardiac Output (CO) be in both parts a and b?d. If her Ejection Fraction (EF) is 77%, using the Stroke Volume from above, what is her End Diastolic Volume (EDV)?e. On average, the normal stroke volume is 70ml. The HR can drop to as low as 20 bpm when sleeping, while it is normally 70 bpm when awake. Compare the cardiac output when a person is at rest to when they are asleep.f. After a heart attack, a patient’s ejection fraction drops to only 20%. His EDV is 135 ml and heart rate is 90 bpm. Calculate SV and CO and compare these values to the normal values.4. You have coronary artery disease caused by atherosclerotic plaques that are occluding two large arteries that feed your heart muscle. You are offered treatment with PCTA, a stent (bare metal or drug-eluting), or CABG. Thinking about the factors we discussed in class, which would you select for yourself and why? Please provide a paragraph (>3 sentences) describing your selection and reasoning.5. (Question adapted from textbook Ch 12 # 13) Please read the New York Times article below (or use the webpage) and then answer the following questions. http://www.nytimes.com/2004/03/21/health/21HEAR.html a. Discuss the advantages of placing more emphasis on prevention of heart disease.b. Discuss the challenges of implementing successful prevention efforts. Why do you think our society places so much more emphasis on treatment of end stage heart disease rather than preventive measures?c. You are given a referral by your internist to see Dr. Waters at the University of California. Your angiogram has shown a narrowing in one of your coronary arteries although you are not currently experiencing any chest pain or other symptoms. After reading this article, if Dr. Waters asked you to join his study and offered you the choice of either joining the patient group who receives angioplasty or the group who receives no angioplasty but instead a strict regimen of cholesterol lowering drugs, which would you chose? Please provide 2-3 sentences explaining your choiceNew Studies Question Value of Opening ArteriesBy GINA KOLATAPublished: March 21, 2004 new and emerging understanding of how heart attacks occur indicates that increasingly popular aggressive treatments may be doing little or nothing to prevent them. The artery-opening methods, like bypass surgery and stents, the widely used wire cages that holdplaque against an artery wall, can alleviate crushing chest pain. Stents can also rescue someone in the midst of a heart attack by destroying an obstruction and holding the closed artery open.But the new model of heart disease shows that the vast majority of heart attacks do not originate with obstructions that narrow arteries.Instead, recent and continuing studies show that a more powerful way to prevent heart attacks in patients at high risk is to adhere rigorously to what can seem like boring old advice — giving upsmoking, for example, and taking drugs to get blood pressure under control, drive cholesterol levels down and prevent blood clotting.Researchers estimate that just one of those tactics, lowering cholesterol to what guidelines suggest, can reduce the risk of heart attack by a third but is followed by only 20 percent of heart patients. "It's amazing and it's completely backwards in terms of prioritization," said Dr. David Brown, an interventional cardiologist at Beth Israel Medical Center in New York. Heart experts say they understand why the disconnect occurred: they, too, at first found it hard tobelieve what research was telling them. For years, they were wedded to the wrong model of heartdisease."There has been a culture in cardiology that the narrowings were the problem and that if you fix them the patient does better," said Dr. David Waters, a cardiologist at the University of Californiaat San Francisco.The old idea was this: Coronary disease is akin to sludge building up in a pipe. Plaque accumulates slowly, over decades, and once it is there it is pretty much there for good. Every year, the narrowing grows more severe until one day no blood can get through and the patient has a heart attack. Bypass surgery or angioplasty — opening arteries by pushing plaque back with a tiny balloon and then, often, holding it there with a stent — can open up a narrowed arterybefore it closes completely. And so, it was assumed, heart attacks could be averted.But, researchers say, most heart attacks do
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