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Homework answers / question archive / MEC, CUNY, BROOKLYN, NY 11225 BIO 323-001: PATHOPHYSIOLOGY LECTURE SPRING 2021: HOME WORK #3 GIVEN:04/16/2021 SUBMIT BY:04/20/2021 Q1) Write short, but comprehensive write-up on:a) Fallot tetralogy b) Congestive cardiac failure c) Cardiomegaly Q2) Write short, but comprehensive write-up on:a) Pulmonary embolism b) Chronic obstructive pulmonary disease (COPD) C) Lung atelectasis Q3) What is Stroke? Give a comprehensive write-up on Stroke

MEC, CUNY, BROOKLYN, NY 11225 BIO 323-001: PATHOPHYSIOLOGY LECTURE SPRING 2021: HOME WORK #3 GIVEN:04/16/2021 SUBMIT BY:04/20/2021 Q1) Write short, but comprehensive write-up on:a) Fallot tetralogy b) Congestive cardiac failure c) Cardiomegaly Q2) Write short, but comprehensive write-up on:a) Pulmonary embolism b) Chronic obstructive pulmonary disease (COPD) C) Lung atelectasis Q3) What is Stroke? Give a comprehensive write-up on Stroke

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MEC, CUNY, BROOKLYN, NY 11225 BIO 323-001: PATHOPHYSIOLOGY LECTURE SPRING 2021: HOME WORK #3 GIVEN:04/16/2021 SUBMIT BY:04/20/2021 Q1) Write short, but comprehensive write-up on:a) Fallot tetralogy b) Congestive cardiac failure c) Cardiomegaly Q2) Write short, but comprehensive write-up on:a) Pulmonary embolism b) Chronic obstructive pulmonary disease (COPD) C) Lung atelectasis Q3) What is Stroke? Give a comprehensive write-up on Stroke. Lexus Lipford FALLOT TETRALOGY Introduction: Tetralogy of Fallot is a genetic condition that causes defects in all four chambers of the heart which includes Ventricular Septal Defect, Overriding Aorta, Pulmonary Stenosis, and Right Ventricular Hypertrophy. Cause: Tetralogy of the Fallot occurs during the development of the heart of a fetus; the direct cause of the defect is unknown Pre-disposing disposing factors: There is no specific cause for this genetic condition, but some factors are believed to make the genetic more likely to occur: Poor maternal condition, Viral Illnesses, Genetic Disorders, alcoholism during pregnancy, Geriatric Pregnancy, Individuals born with the Fallot Tetralogy. Epidemiology: Tetralogy of Fallot is a rare congenital malformation of the heart that occurs more frequently in males than females. Approximately 1 percent of newborns have congenital heart defects. About 10 percent of these infants are diagnosed with tetralogy of Fallot. This heart defect is usually detected weeks or months after birth. The prevalence of tetralogy of Fallot is estimated to be 1 in 3,000 live births. The prevalence of TOF in the United States is approximately 4 to 5 per 10,000 live births. This defect accounts for approximately 7 to 10 percent of cases of congenital heart disease and is one of the most common congenital heart lesions requiring intervention in the first year of life. TOF occurs equally in males and females. Children with chromosome disorders, such as Down syndrome, often have tetralogy of Fallot and other congenital heart diseases. Signs & Symptoms: > > > > > > > > > Cyanosis SOB/Rapid breathing Syncope Clubbing of fingers and toes Malnutrition/Difficulty gaining weight Irritability Prolonged Crying Heart Murmur Easily Fatigued Diagnosis: Tetralogy can be seen through an ultrasound, and if suspected can be confirmed by doing a fetal echocardiogram. Treatment: Further progression and observation of the defect can be monitored by additional radiologic exams like cardiac magnetic resonance imaging (MRI), X-ray of the chest, cardiac catherization, and pulse oximetry. Surgery: People diagnosed with Tetralogy can undergo several different surgeries to temporarily or completely repair defects within the heart that include: Blalocking-Taussig (BT) shunt to increase blood flow to the lungs, Ventricular Septal Defect (VSD), and surgical procedures to relieve narrowing between the right ventricles and pulmonary artery. Medication: Vasodilators, Alprostadil, Diuretics, Furosemide (Lasix), Alpha1 Agonists, Phenylephrine, Beta-Blockers, Metoprolol (Lopressor, Toprol) Prognosis/Complications: Blood clots that can lead to stroke, Infection of the lining of the heart and heart valves, abnormal heart rhythms, heart failure, and death Prevention: There is no prevention for the Tetralogy, but only therapies and treatment to lessen the symptoms. CONGESTIVE CARDIAC FAILURE Introduction: A chronic progressive condition that weakens the pumping mechanism of the heart. Cause: Develops when ventricles of. the heart can’t efficiently pump blood volume to the body leading to a buildup of blood and other fluids in organs and several parts of the body. Pre-disposing disposing factors: Those who have a familial history of chronic illnesses like diabetes and high blood pressure are especially cautioned. High blood pressure, Coronary Artery Disease, Heart Attack, Diabetes, Sleep Apnea, Congenital Heart defects, Valvular Heart Disease, Viruses, Alcohol abuse, Tabacco abusive, Obesity, Irregular Heartbeat (Heart Murmur), Pharmeceutical Drug Induced, e.g., Diabetes medications like Actos and Nonsteroidal Anti-inflammatory (NSAIDS), some anesthesia, anti-arrhythmic Medications are among those increases risk of heart problems. Epidemiology: About 6.2 million adults in the United States have heart failure. In 2018, heart failure was mentioned on 379,800 death certificates (13.4%). Heart failure costs the nation an estimated $30.7 billion in 2012.2This total includes the cost of health care services, medicines to treat heart failure, and missed days of work. Signs & Symptoms: > > > > > > > > > > Edema/Excess fluid in the body tissues (legs, feet, ankles) Ascites Wheezing or Coughing (Pink, foamy mucus) Shortness of Breath (Dyspnea) Irregular weight gain Fatigue Increased Heart Rate Nausea Loss of Appetite Altered Mental Status/Confusion/Disorientation Diagnosis: Congestive Heart Failure can be detected through several diagnostic tests which includes a blood panel called N-terminal pro-B-type natriuretic peptide (NT-proBNP), radiologic exams like Chest X-rays, Electrocardiogram (ECG), Echocardiogram, Stress test, Cardiac Computerized tomographs (CT scan), Magnetic resonance imaging (MRI), Coronary angiogram, Ejection fraction, and lastly a myocardial biopsy can be used to pathologically confirm a diagnosis. Treatment: Heart failure is a chronic disease that requires lifelong management. With the aid of treatment of underlining conditions signs and symptoms can improve and strengthen the heart, ultimately if all treatment and management are unsuccessful if a good candidate the patient can receive a heart transplant. Surgery: Coronary artery bypass grafting surgery, Heart valve surgery, Implantable left ventricular assist device (LVAD), Heart transplant. Medication: ACE inhibitors to aid in dilating blood vessels, Beta-blockers both reduce blood pressure and over working of the heart, Diuretics to reduce fluid retention throughout the body. Prognosis/Complications: Kidney damage and failure, heart valve problems, heart rhythm problems, and liver damage. Prevention: Reducing risk factors are a key component of preventing heart failure by making lifestyle changes which include not smoking, healthy diet and exercise, maintaining a healthy weight, reducing and managing stress, controlling chronic conditions such as high blood pressure, diabetes. CARDIOMEGALY Introduction: A condition in which the heart is enlarged. Cause: Cardiomegaly is a condition that one can be born with because congenital heart diseases or developed from damage from cardiac diseases and conditions. Pre-disposing disposing factors: High Blood Pressure, Heart Valve Disease, Cardiomyopathy, Pulmonary Hypertension, Pericardial Effusion, Coronary Artery Disease, Anemia, Thyroid Disorders, Excessive Iron in the Body (Hemochromatosis), Rare Diseases that can affect the heart like Amyloidosis, Familial History of Cardiomegaly or Cardiomyopathy, Congenital Heart Disease Epidemiology: Enlargement of the heart both in the form of dilatation or hypertrophy leads to a spectrum of clinical heart failure syndrome, with a prevalence of nearly 5.8 million people in the United States. Heart failure with preserved Ejection Fraction (HFpEF) represents more than half of these cases. The incidence of heart failure increases with age, male gender, and African American race. About half of the people diagnosed with heart failure die within 5 years of diagnosis. Signs & Symptoms: > > > > > > > Shortness of Breath (SOB) Abnormal Heartbeat (Arrhythmia) Swelling (Edema) Chest pain Coughing (Increased while Lying Flat) Dizziness Fatigue Diagnosis: Cardiomegaly can be detected through radiologic testing like Echocardiogram, Chest X-Ray, CT scan, and Electrocardiogram (EKG). Once diagnosed a licensed provider can run further assessments and exam to determine underlying causes which include a full physical exam, blood panels, stress tests, and cardiac catherization. Treatment: For all Cardiomegaly conditions mild to severe treatment and maintenance of underlying conditions are most vital. If gone untreated cardiomegaly condition can worsen. Surgery: Those suffering from cardiomegaly can go through surgical treatments to help lessen worsening conditions like the insertion of medical devices to regulate heartbeat like LVAD and pacemakers, repairing heart valves, coronary bypass surgery, and if all treatment fails heart transplant. Medication: Diuretics to relieve fluid retention, Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure and improve heart pumping capabilities or Angiotensin II Receptor Blockers (ARBs) as an alternative to ACE inhibitors, Beta blockers lower BP and improve heart function, Anticoagulants to avoid clotting of the blood, and Anti-Arrythmias to aid in keeping a normal heart rhythm. Prognosis/Complications: Heart failure, Blood clots, Heart murmur, Cardiac arrest, and sudden death. Prevention: If caught early cardiomegaly conditions can be managed preventing the disease from worsening. Those with familial history of conditions that can cause Cardiomegaly (enlarged heart), or if the condition itself runs in your family should report it to their physician to develop a preventive plan. Lifestyle changes that reduce risk factors include practicing a healthy eating diet and exercise regimen. Avoiding overuse or abuse of tobacco, alcohol, or illicit drugs. PULMONARY EMBOLISM Introduction: Pulmonary embolism is a blockage in the pulmonary artery Cause: Blood clots travel from the deep veins within the legs more commonly, but also in some rare cases can come from other parts of the body. Pre-disposing disposing factors: Those who have been inactive or immobile for long periods of time (e.g., post-surgery, or sudden trauma), Inherited blood disorders or factor V Leiden, Broken bones, Having or history of cancer or Chemotherapy. Other key factors include being overweight/obese, Smoking cigarettes, being pregnant or given birth, Oral contraceptives or Hormone replacement therapies, Injury or trauma to a vein, Severe injuries like burns, or fractures to hip or Thigh bones, Stroke, Paralysis, Chronic Heart Disease, or Hypertension. Individuals >60. Epidemiology: Pulmonary Embolisms are estimated to be approximately 60 to 70 per 100,000, and that of venous thrombosis approximately 124 per 100,000 of the general population. European guidelines for the diagnosis and management of PE report annual incidence rates of venous thrombosis and PE of approximately 0.5 to 1.0 per 1000 inhabitants, however, the actual figures are likely to be substantially higher because silent PE can develop in up to 40% to 50% of patients with deep vein thrombosis (DVT). In addition, autopsy studies have shown that PE had been diagnosed before death in 30% to 45% of patients. After coronary artery disease and stroke, acute PE ranks third among the most common types of cardiovascular diseases. Most cases of PE occur at 60 to 70 years of age, autopsy data show the highest incidence among individuals 70 to 80 years of age. If untreated, acute PE is associated with a significant mortality rate as high as 30%, whereas the death rate of diagnosed and treated PE is 8%. Up to 10% of acute PE patients die suddenly. Signs & Symptoms: > > > > > Chest pain Sudden SOB/Trouble breathing Coughing with or without bloody sputum (mucus) Irregular Heartbeat (Arrythmia) Swelling of the leg or along a vein in the Leg > > > > > > > Pain or Tenderness of the leg Abnormal warmth of the leg that is swollen or painful Redness or discolored skin of affected leg Anxiety Cyanosis Sweating, Clammy skin Feeling lightheaded or Syncope Diagnosis: A(n) Pulmonary Embolism can be detected by patient's medical history, physical exam, or test results which include Ultrasound of the leg, CT scan, Lung Ventilation Perfusion scan, Pulmonary angiography, Blood panels, Echocardiography, Electrocardiogram, Chest X-Ray, Chest MRI. Treatment: Pulmonary embolisms can be treated with medicines, procedures, and other aiding therapies. Surgery: Vena cava filters can be placed within the inferior vena cava preventing clots from traveling to the lungs, and Pulmonary Thromboendarterectomy (PTE) to remove clots. Medication: PEs are treated using Anticoagulation drugs and/or blood thinners to aid in the decrease blood’s clotting factors. Prognosis/Complications: Abnormal heart rhythms, Cardiac arrest and sudden death, necrosis of part of the lung due to pulmonary infraction, pleural effusion, paradoxical embolism, pulmonary hypertension, shock Prevention: Pulmonary embolisms can be avoided by practicing a healthy diet and staying physically active as well as staying away from smoking. LUNG ATELECTASIS Introduction: The complete or partial collapse of the entire lung or lobe of the lung. Cause: Lung Atelectasis occurs from the obstruction of an airway or pressure from the outer parts of the lung. Obstructive Lung Atelectasis: Buildup of mucus plug in airways, bodies obstructing airways, and an abnormal tumoral foreign growth narrowing the airway. Nonobstructive Atelectasis: Trauma to chest caused by a fall or car accident, Pleural effusion, Pneumonia, Pneumothorax, Scarring of lung tissue, tumor. Pre-disposing disposing factors: Those older in age, conditions causing difficulty swallowing, lung disease (asthma, COPD, bronchiectasis, cystic fibrosis), immobility, Recent surgical procedures of the abdomen or chest, recent administration of general anesthesia, weakened breathing due To muscular dystrophy, spinal cord injury or another neuromuscular condition, pain or injury that makes coughing Difficult, medications that cause shallowing breathing, smoking Epidemiology: Atelectasis does not specifically affect either sex. Also, there is no increased incidence of atelectasis in patients with COPD, asthma, or increased age. It is more commonly in patients who recently underwent general anesthesia, with the odds of occurrences being as high as 90% in this patient population. Research has shown that atelectasis appears in the dependent regions of both lungs within five minutes of induction of anesthesia. Atelectasis is more prominent after cardiac surgery with cardiopulmonary bypass than after other types of surgery, including thoracotomies. Patients undergoing abdominal and/or thoracic procedures are at increased risk of developing atelectasis. Obese and/or pregnant patients are more likely to develop atelectasis due to cephalad displacement of the diaphragm (see the section on epidemiology). Signs & Symptoms: > > > > > > > Difficulty breathing (SOB) Rapid/Shallow breathing Wheezing Cough Increased heart rate Chest pain Cyanosis of the skin and lips Diagnosis: Lung Atelectasis can be diagnosed by running a series of diagnostic tests which includes CT scan, Oximetry, ultrasound of thorax, Bronchoscopy where a light scope is inserted down the throat to see what is causing the blockage on the airway. Treatment: Mild cases of Lung Atelectasis can go away without any treatment; however, more severe cases require medication therapies to help loosen and thin out mucus build up. Chest physiotherapy is also recommended to help aid in the clearing the airways by deep breathing exercises, tapping on the chest, and positioning the body so that the head is lower the chest (postural drainage). Surgery: Removal of airway obstructions by bronchoscopy and suctioning mucus. In more severe cases where a tumor is causing the obstruction treatment may involve removal or shrinkage of the tumors with surgery with or without cancer therapies such as chemotherapy and radiation. Medication: Bronchodilators decrease muscle tone in small and large airways (albuterol), Systemic Corticosteroids like Prednisone, Prednisolone, Corticosteroid and bronchodilators combinations like Fluticasone. Prognosis/Complications: Mild cases of atelectasis are usually treatable, but in some more serious cases it can cause low blood oxygen (hypoxemia), pneumonia, and ultimately respiratory failure can occur resulting in the loss of a lobe or whole lung. Prevention: In children, the risk of Atelectasis can be prevented by keeping small objects out of reach. While in adults, it commonly occurs. after. major surgery or. Injury in which. preventative measures can be discussed with the doctor managing care, breathing exercises and muscle training can significantly lower risk of atelectasis nonobstructive atelectasis. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Introduction: A chronic inflammatory lung disease that leads to obstructed airflow from the lungs Cause: COPD is caused by long-term exposure irritants that damage the lungs and airways like smoking, secondhand smoking, air pollution, and chemical fumes and dusts inhalation. There is also a TIA or transient ischemia attack which causes a temporary disruption of blood flow to the brain. Pre-disposing disposing factors: Smoking is the leading risk factor for developing chronic obstructive pulmonary disease (COPD), but other risks include but are not limited to exposure to air pollution, secondhand smoking, working with hazardous chemicals, dusts, and fumes, genetic disorders called Alpha-1 deficiency. Epidemiology: Chronic obstructive pulmonary disease (COPD) is responsible for early mortality, high death rates and significant cost to health systems. The projection for 2020 indicates that COPD will be the third leading cause of death worldwide; from sixth in 1990 and fifth leading cause of years lost through early mortality or handicap. Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex. This disease is also associated with significant comorbidities. COPD is a disorder that includes various phenotypes, the continuum of which remains under debate. The major challenge in the coming years will be to prevent onset of smoking along with early detection of the disease in the general population. Signs & Symptoms: > > > > > > > > Shortness of Breath Tightness in the chest Wheezing Chronic cough Frequent respiratory infections Fatigue Abnormal weight loss Edema (swelling of the ankles, legs or feet) Diagnosis: COPD can be detected through several tests that includes Lung (Pulmonary) function tests, Chest X-rays, CT scans, arterial blood gas (ABG), laboratory tests to determine if the genetic disorder aplha-1-antitryspin deficiency is present. Treatment: Oxygen therapies and pulmonary rehabilitation programs are treatments to help aid in quality of life for those living with COPD. In-home non-invasive ventilation therapies like BiPAP helps to improve breathing and decrease retention of carbon dioxide (hypercapnia) preventing acute respiratory failure. Surgery: Procedures that are available to those who are more severely affected by COPD are Lung volume reduction surgery, Lung transplant, and bullectomy the removal of the bullae from the lungs to improve airflow. Medication: Bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors, theophylline, antibiotics Prognosis/Complications: Several complications can present themselves from COPD which includes frequent respiratory infections, heart problems, lung cancer, high blood pressure in lung arteries, and can lead to depression due to the inability to do normal activities. Prevention: The most effective way to prevent COPD is to never begin smoking or quit smoking. Avoiding being overly present while someone else is smoking and avoiding over exposure to hazardous chemicals and dusts. STROKE Introduction: A stroke is when the blood supply to part of your brain Cause: Strokes have two main causes the first a blocked artery known as an ischemic stroke the other is the leaking or busting of a blood vessel known as hemorrhagic stroke. Pre-disposing disposing factors: **African Americans, Alaska Native, American Indians, and Hispanic adults are all more likely to suffer from strokes. Men are also more likely to suffer from a stroke at a younger age, but due to the longer live expectancy of women, the risk for having a stroke is higher** Familial history of hypertension/stroke, those of older age, diabetes, hypertension, high LDL cholesterol levels, heart or blood pressure disease, smoking, brain aneurysms or arteriovenous malformations, viral infections or conditions Epidemiology: Over the past 30 years or more, both stroke incidence and mortality have decreased. The rate of stroke in patients on Medicare over 65 years of age declined 40% from 1988 to 2008, and the age-adjusted stroke death rate decreased 33.7% from 2003 to 2013.The rate of recurrent stroke is declining as well. In control patients pooled from stroke prevention trials, the annual rate of recurrent stroke fell from 8.71% in the 1960s to 4.98% in the 2000s, with the current annual rate estimated to be between 3% and 4%. Recurrent stroke is associated with a larger risk factor burden, and improvements in stroke prevention over recent decades correspond to improved risk factor management, including higher rates of statin (4% to 41.4%) and antihypertensive (53% to 73.5%) use between 1992 and 2008. Signs & Symptoms: > > > > > > > > Trouble speaking or understanding Paralysis or numbness of the face, arm, leg Difficulty seeing in one or both eyes Headache Trouble walking/Unsteady gait Loss of consciousness Seizure Nausea Diagnosis: A stroke can be detected by physical exam motor skills and cognitive functions are tested through a series of exercises; blood test used to determine the clotting factor of your blood. They can also be visually seen in diagnostic radiologic test like CT scans, MRI, Carotid ultrasound, or Cerebral angiogram. Treatment: Emergency IV medications are used to aid in the breaking up of the clot; given within the first 4.5 hours from the initial presentation of symptoms. In some other cases, surgical procedures are performed to relieve clots, repair bleeding, or relieve pressure. Surgery: Craniotomy, Carotid Enterectomy performed to clear plaque blocking the carotid artery; reducing chances of ischemic stroke, Angioplasty and stents are used to catheter through the carotid arteries through the groin where a balloon is inflated to expand the narrowing artery. The stent is inserted to support the newly opened artery. Surgical clipping to stop blood flow to the aneurysm, coiling (endovascular embolization) a catheter is inserted into an artery in the groin and guided to the brain depositing detachable coils into the aneurysm to fill it blocking blood flow to the aneurysm. Surgical AVM removal, and Stereotactic radiosurgery uses multiple beams of focused radiation to repair blood vessels. Medication: Anticoagulants (Coumadin, Jantoven), Antiplatelet (Plavex) preventative medication aiding in the anticoagulation and clotting factor, Tissue plasminogen activator (TPA) administered to break up blood clots, Statins (Lipitor) aid in lowering cholesterol levels, blood pressure medications which include beta blockers, angiotensin, and calcium channel blockers Prognosis/Complications: Some of the complications from having a stroke includes paralysis or total loss of muscle movement, difficulty swallowing or talking, loss of memory of thinking difficulties. In a small stroke it may just lead to weakness of the extremities, in more severe cases total loss of movement in parts of the body. Thos who suffered from strokes are also prone to experience mood swings and may even develop depression because of the decline in quality of life due to inability to function as normal during daily activities. Prevention: Preventative measures can be made for those with familial history to strokes and others by controlling blood pressure, lowering the intake of saturated fats and foods high in cholesterol, quit or not smoking, maintaining a healthy weight, and managing other conditions like diabetes.

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