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. With rupture 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 Weakness of face Weakness of the arm Unilateral numbness Vision loss in one eye Language disturbance Aphasia Sudden, unexplained imbalance or ataxia As manifested by patient + August 2, 2013 + August 2, 2013 + August 2, 2013 + 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

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 Chest pain or discomfort Pain in arms, neck, jaw, shoulder or back accompanying chest pain Nausea 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). As manifested by patient + August 2, 2013 + August 2, 2013 -

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 High blood pressure Enlarged heart and irregular heartbeat Fluid in the lungs or lower extremities Unusual heart sounds

As manifested by patient + August 2010 + August 10, 2013 -

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 Fatigue Irritability Polyuria Polydipsia Slow healing of skin wounds Vaginal infections Blurred vision Increased hunger Weight loss Areas of darkened skin As manifested by patient + August 10, 2013 + August 10, 2013 + August 10, 2013

SCHEMATIC DIAGRAM Predisposing Factors Obesity Race/Ethnicity History of GDM Delivery of babies over 9Ilbs Precipitating Factors Increased carbohydrate and fat intake Lack of exercise History of smoking History of alcoholism Family history Gender: Female Age>45: 64 years old