Learninggoals case 11
ADDITION CASE 10
EXAM QUESTION case 9: Form hypothesis about question and think about directions and strengths of
relations between each other. Understand what an ICC is and how you interpreter is. What is
absolute (SEM) and relative reliability (ICC)? Evaluation very small SEM, cross sectional SEM can be
higher because you need to distinguish people, the data should be far away from each other and
then you can afford more SEM.
You can chose your own gold standard from literature or own experience as researcher. It is not
something which is determined by someone else. There is no real gold standard. Don’t do gold
standard tests if you think there is no better than your measurement, then use the correlation
instead of sensitivity or specificity.
Face validity = complicated research step because you have to do a lot of qualitative research to find
out to figure out to what you want to measure and the way you are going to do it is a correct
reflection of what you want to know. For example a questionnaire have to make sense for the
participants (leken), this can differ between country or per language.
Coronary heart disease
The process of narrowing of the arteries as a result of formation of fatty plague is called
atherosclerosis. When coronary arteries are involved, this is termed coronary heart disease (CHD).
As the disease progresses and the coronary arteries become narrower, the capacity to supply blood
to the myocardium is progressively reduced. As the narrowing worsens, the myocardium (heart
muscle) eventually can’t receive enough blood to meet all of its needs. When this occurs..
- the portion of the myocardium that is supplied by the narrowed arteries becomes ischemic,
meaning that it suffers a deficiency of blood, or ischemia. This can lead to pain in the chest
(angina pectoris), especially in periods of stress when the demands on the heart are greatest.
- Eventually this can lead to a myocardial infarction (heart attack), cardiac muscle cells that
are deprived of blood for several minutes are thus deprived of oxygen, which leads to
irreversible damage and necrosis (cellular death). This can lead to mild, moderate, or severe
disability or even death, depending on the location of the infarction and the extent of the
damage.
Hypertension
Medical term for high blood pressure, a condition in which blood pressure is chronically elevated
above levels considered desirable or healthy for a person’s age and size.
Hypertension causes…
- the heart to work harder than normal, because it has to expel blood from the left ventricle
against a greater resistance
- places great strain on the systemic arteries and arterioles.
Over time, this stress can cause the heart to enlarge and the arteries and arterioles to
become scarred, hardened, and less elastic. Eventually, this can lead to atherosclerosis,
heart attacks, heart failure, stroke, and kidney failure.
Stroke
Form of cardiovascular disease that affects the cerebral arteries, those that supply the brain.
, The consequences depend largely on the location and extent of the stroke. Brain damage from a
stroke can affect the senses, speech, body movement, thought patterns, and memory. Paralysis on
one side of the body is common, as is the inability to verbalize thoughts
Two categories:
- Ischemic stroke (most common!): result from an obstruction within a cerebral blood vessel
that limits the flow of blood to that region of the brain. Blood flow beyond the blockage is
restricted, and the part of the brain that relies on that supply becomes ischemic, is oxygen
deficient, and can die.
Obstructions have one of two causes:
Cerebral thrombosis (most common!) a thrombus (blood clot) forms in a cerebral
vessel, often at the site of atherosclerotic damage to the vessel.
Cerebral embolism an embolus (an undissolved mass of material, such as fat
globules, bits of tissue, or a blood clot) breaks loose from another site in the body
and lodges in a cerebral artery. An irregular heartbeat, atrial fibrillation, creates
conditions in which clots can form in the heart, dislodge, and then travel to the brain
- Hemorrhagic stroke: rupture in vessels, the blood leaves the vessel at the site of injury. Also,
as the blood accumulates outside of the vessel, it puts pressure on the fragile brain tissue,
which can alter brain function. Brain hemorrhages often result from aneurysms, which arise
from weak spots in the vessel wall that balloon outward; and aneurysms often arise because
of hypertension or atherosclerotic damage to the vessel wall
Intracerebral haemorrhage one of the cerebral arteries ruptures in the brain
Subarachnoid haemorrhage one of the brain’s surface vessels ruptures, dumping
blood into the space between the brain and the skull
Heart failure
a chronic and progressive clinical condition in which the heart muscle (myocardium) becomes too
weak to maintain an adequate cardiac output to meet the body’s blood and oxygen demands.
This usually results from either damage to, or overworking of, the heart. When cardiac output is
inadequate, blood begins to back up in the veins. This causes excess fluids to accumulate in the
body, particularly in the legs and ankles. This fluid accumulation (edema) also can affect the lungs
(pulmonary edema), disrupting breathing and causing shortness of breath. Heart failure can
progress to the point of irreversible damage to the heart, and the patient becomes a candidate
for a heart transplant
Possible causes:
- Hypertension (75%)
- Atherosclerosis
- Valvular heart disease
- Viral infection
- Heart attack
Metabolic syndrome
About 25% of the US adult population has the metabolic syndrome.
Is a cluster of at least 3 of 5 of these conditions:
- Central obesity
- High blood pressure
- High blood sugar
- High serum triglycerides
- Low serum HDL
