Julie Edwards, a 37-year-old woman, was working in her yard when she received a sting on the right wrist from a yellow jacket wasp. Several minutes later she complained of an itching sensation and cramping abdominal pain. She then became acutely short of breath with wheezing. A patchy erythema radiating from the area of the sting was noted along with swollen eyelids and lips. A neighbor took her to an emergency center where she became very faint. Vital signs were: blood pressure 60/34; pulse 156; respirations 40. Epinephrine was immediately administered intravenously along with 100 mg of hydrocortisone.
Within minutes, an improvement in the respiratory rate was noted and blood pressure increased to 100/70 with a pulse rate of 112.
1. Explain the pathophysiologic mechanism involved in producing the clinical picture.
Mr. Joe Brown is a 60 year old Caucasian male who sought medical attention due to increasing problems with intermittent claudication and loss of color in the left leg. He was found to have absent pulses in the left foot even with Doppler studies. A femoral arteriogram showed complete occlusion of the femoral artery several inches above the left knee. Extensive collateral circulation could be seen and the dorsalis pedis artery was weakly outlined. Except for a history of tobacco smoking, no other risk factors were identified. No other atherosclerotic lesions were noted. A femoral popliteal bypass was recommended to restore circulation to the left foot.
1. Describe the process of atherosclerotic occlusion of a vessel.
2. What is the basis for the development of collateral circulation?
Mr. Charles Dow, a 43 year old, white business executive, was brought to the emergency room of a local hospital following successful resuscitation of collapse and ventricular fibrillation by advanced cardiac life support measures at his home. His wife indicated that he had in recent weeks complained of tightness in the chest following activity and eating. Mr. Dow is approximately 5’10” and weighs 265 pounds. He has a history of smoking one pack per day and is trying to quit. His serum cholesterol is 342 with an HDL of 38. He recently was laid off from his job. Lab data include a CPK of 1620. EKG reveals frequent PVCs and inverted T” wave.
1. What is the significance of the laboratory and EKG data in terms of time of disease onset?
2. What is the probable cause of the collapse and ventricular fibrillation suffered by the patient?
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