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TEXTBOOK DISCUSSION

A. Definition

Cerebrovascular diseases

Cerebrovascular disease encompasses a number of disorders involving vessels in the cerebral

circulation. These disorders include stroke and transient ischemic attacks (TIAs), aneurysmal

subarachnoid hemorrhage, and arteriovenous malformations.

Stroke is the syndrome of acute focal neurologic deficit from a vascular disorder that injures

brain tissue. The term brain attack has been promoted to highlight that time-dependent tissue

damage occurs and to raise awareness of the need for rapid emergency treatment, similar to

that with heart attack.

There are two main types of strokes: ischemic and hemorrhagic.

Ischemic Stroke

Ischemic strokes are caused by cerebrovascular obstruction by thrombosis or emboli. A

common classification system identifies five stroke subtypes: ischemic penumbra in evolving

stroke, transient ischemic attack, large vessel stroke, small vessel stroke, and cardiogenic

embolic stroke.

Hemorrhagic Stroke

The most frequently fatal stroke is a spontaneous hemorrhage into the brain substance. Withrupture of a blood vessel, hemorrhage into the brain tissue occurs, resulting in edema,

compression of the brain contents, or spasm of the adjacent blood vessels. In the most

common situation, hemorrhage into the basal ganglia results in contralateral hemiplegia, with

initial flaccidity progressing to spasticity. The hemorrhage and resultant edema exert great

pressure on the brain substance, and the clinical course progresses rapidly to coma and

frequently to death.

B. Signs and symptoms

According to textbook As manifested by patient

Weakness of face -

Weakness of the arm + August 2, 2013

Unilateral numbness -

Vision loss in one eye -

Language disturbance + August 2, 2013

Aphasia + August 2, 2013

Sudden, unexplained imbalance or ataxia + August 2, 2013

A. Definition

Unstable Angina (NonST-Segment Elevation Myocardial Infarction)

Unstable angina is considered to be a clinical syndrome of myocardial ischemia ranging

between stable angina and myocardial infarction. It most frequently results from

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atherosclerotic plaque disruption, platelet aggregation, and secondary hemostasis.In contrast

to stable angina, the pain associated with unstable angina has a more persistent and severe

course and is characterized by at least one of three features: (1) it occurs at rest usually lasting

more than 20 minutes; (2) it is severe and described as frank pain and of new onset; and (3) it

occurs with a pattern that is more severe, prolonged, or frequent than previously experienced.Persons who have no evidence of serum markers for myocardial damage are considered to

have unstable angina, whereas a diagnosis of nonST-segment elevation myocardial infarction

is indicated if a serum marker of myocardial injury is present.

B. Signs and symptoms

According to textbook As manifested by patient

Chest pain or discomfort + August 2, 2013

Pain in arms, neck, jaw, shoulder or back

accompanying chest pain

-

Nausea + August 2, 2013

Fatigue -

Shortness of breath -

Excessive sweating -

Dizziness -

A. Definition

Hypertensive Cardiovascular Disease

Uncontrolled and prolonged elevation of BP can lead to a variety of changes in the myocardial

structure, coronary vasculature, and conduction system of the heart. These changes in turn can

lead to the development of left ventricular hypertrophy (LVH), coronary artery disease (CAD),

various conduction system diseases, and systolic and diastolic dysfunction of the myocardium,

complications that manifest clinically as angina or myocardial infarction, cardiac arrhythmias

(especially atrial fibrillation), and congestive heart failure (CHF).

Thus, hypertensive heart disease is a term applied generally to heart diseases, such as LVH,coronary artery disease, cardiac arrhythmias, and CHF, that are caused by the direct or indirect

effects of elevated BP. Although these diseases generally develop in response to chronically

elevated BP, marked and acute elevation of BP can lead to accentuation of an underlying

predisposition to any of the symptoms traditionally associated with chronic hypertension.

B. Signs and Symptoms

According to textbook As manifested by patient

High blood pressure + August 2010

Enlarged heart and irregular heartbeat -

Fluid in the lungs or lower extremities + August 10, 2013

Unusual heart sounds -

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A. Definition

Type 2 Diabetes

The two main problems related to insulin in type 2 diabetes are insulin resistance and impaired

insulin secretion. Insulin resistance refers to a decreased tissue sensitivity to insulin. Normally,insulin binds to special receptors on cell surfaces and initiates a series of reactions involved in

glucose metabolism. In type 2 diabetes, these intracellular reactions are diminished, thus

rendering insulin less effective at stimulating glucose uptake by the tissues and at regulating

glucose release by the liver. The exact mechanisms that lead to insulin resistance and impaired

insulin secretion in type 2 diabetes are unknown, although genetic factors are thought to play a

role.

To overcome insulin resistance and to prevent the buildup of glucose in the blood, increased

amounts of insulin must be secreted to maintain the glucose level at a normal or slightly

elevated level.

B. Signs and symptoms

According to textbook As manifested by patient

Fatigue -

Irritability + August 10, 2013

Polyuria -

Polydipsia -

Slow healing of skin wounds -

Vaginal infections -Blurred vision + August 10, 2013

Increased hunger -

Weight loss -

Areas of darkened skin + August 10, 2013

SCHEMATIC DIAGRAM

Predisposing Factors Precipitating Factors

Obesity Increased carbohydrate and fat intake

Race/Ethnicity Lack of exercise

History of GDM History of smoking

Delivery of babies over 9Ilbs History of alcoholism

Family history

Gender: Female

Age>45: 64 years old