Family history of heart disease is an inherited risk factor that is not subject to a lifestyle change. Having a first-degree relative with heart disease has been shown to significantly increase risk. ASCVD is multifactorial etiology. The most common risk factors include hypercholesterolemia (LDL-cholesterol), hypertension, diabetes mellitus, cigarette smoking, age (male older than 45 years and female older than 55 years), male gender, and strong family history (male relative younger than 55 years and female relative younger than 65 years).

Option B: Also, a sedentary lifestyle, obesity, diets high in saturated and trans-fatty acids, and certain genetic mutations contribute to risk. While a low level of high-density lipoprotein (HDL)-cholesterol is considered a risk factor, pharmacological therapy increasing HDL-cholesterol has yielded negative results raising concerns about the role of HDL in ASCVD.
Option C: Smoking is a risk factor that is subject to lifestyle change and can reduce risk significantly. For the most part atherosclerosis and its pathology can be prevented. All healthcare workers who look after patients should educate patients on the need to exercise regularly, discontinue smoking, maintain healthy body weight, eat a healthy diet, and remain compliant with the medications used to lower lipids.
Option D: Advancing age increases the risk of atherosclerosis but is not a hereditary factor. It has been reported that 75% of acute myocardial infarctions occur from plaque rupture and the highest incidence of plaque rupture was observed in men over 45 years; whereas, in women, the incidence increases beyond age 50 years.

Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle tissue, and usually relieved after rest. The tissue becomes hypoxic, causing cramping, weakness, and discomfort.

Option A: Intermittent claudication (IC) typically refers to lower extremity skeletal muscle pain that occurs during exercise. IC presents when there is insufficient oxygen delivery to meet the metabolic requirements of the skeletal muscles.
Option B: Pain occurs during activity when demand increases in muscle tissues, not when at rest. IC is commonly localized to the thigh, hip, buttock, and calf muscles. Pain within these muscle groups is reproducibly induced by walking and relieved with rest. The severity of pain can sometimes correlate with the degree of stenosis or blockage in arteries supplying the lower extremities.
Option C: The key feature of intermittent claudication is that the muscle discomfort is reproducible. The pain usually comes on during physical activity and subsides after a period of rest. The key reason for the pain is inadequate blood flow.
Option D: Physical examination of these patients may show evidence of arterial insufficiency. The affected limb may feel cool and have diminished pulses. The physical examination should include an assessment of femoral, popliteal, dorsalis pedis, and posterior tibial artery pulses.
Option E: Structured walking programs improve pain-free walking distance better than pharmacologic therapy alone. It is important to note that continued smoking with walking therapy restricts improvement in these patients.

Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Place the client’s legs in a dependent position in relation to the heart to improve peripheral blood flow. Keep the client in a neutral, flat, supine position if in doubt about the nature of his peripheral vascular problems.

Option A: Walking barefoot is not advised, as foot protection is important to avoid trauma that may lead to serious infection. Randomized trials have shown supervised exercise therapy programs to have significant improvement in claudication symptoms. A meta-analysis of 27 studies found exercise significantly improved pain-free walking distance by 269 feet and total walking distance by nearly 400 feet.
Option B: Heating pads can cause injury, which can also increase the risk of infection. Never apply a direct heat source to the extremities. Limited blood flow combined occurs with normal circulation. Provide insulating warmth with gloves, socks, and other outerwear as appropriate.
Option D: Skin lesions at risk for infection should be examined and treated by a physician. If overreplacement of glucocorticoid is indicated, inform the client about the purpose of therapy and possible adverse effects such as cushingoid appearance, weight gain, acne, hirsutism, peptic ulcer, diabetes mellitus, osteoporosis, infection, muscular weakness, mood swings, cataracts, and hypertension.

Raynaud’s disease is most common in young women and is frequently associated with rheumatologic disorders, such as lupus and rheumatoid arthritis. Secondary Raynaud phenomenon is associated with different etiologies. It is most commonly associated with connective tissue disorders such as scleroderma, systemic lupus erythematosus, Sjogren syndrome, and antiphospholipid syndrome.

Option A: Primary Raynaud phenomenon usually occurs in the second or third decade of life, with a baseline prevalence rate of 8% in men. Occupations that result in overt vibrational exposure from vibrating machinery mostly affect males. This is known as hand-arm vibration syndrome. Exposure to polyvinyl chloride, cold injury from work, or ammunition work are other occupational-associated causes of secondary Raynaud phenomenon.
Option B: Primary Raynaud phenomenon usually occurs in the second or third decade of life. Secondary Raynaud phenomenon occur more frequently in women (about 20% to 30%), particularly in younger age populations (teens to 20s). The female to male ratio is 9 to 1.
Option D: Primary Raynaud phenomenon occurs more frequently in women than in men. In the population of patients older than 60 years, obstructive vascular disease is a frequent cause of the Raynaud phenomenon. Obstructive vascular disease causes include thromboangiitis obliterans, microemboli, diabetic angiopathy, or atherosclerosis

In a hospitalized patient on prolonged bed rest, the most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Most pulmonary embolisms originate as lower extremity DVTs. Hence, risk factors for pulmonary embolism (PE) are the same as risk factors for DVT. Virchow’s triad of hypercoagulability, venous stasis, and endothelial injury provides an understanding of these risk factors.

Option A: Smoking and abnormal apolipoprotein ratio showed the strongest association with acute myocardial infarction. The increased risk associated with diabetes and hypertension were found to be higher in women, and the protective effect of exercise and alcohol was also found to be higher in women.
Option C: There is no reason to suspect an anxiety disorder in this patient. Pregnancy is one of the most important events in women’s lives. Being pleasant, it is one of the most stressful events in a woman’s life, as psychologists have cited, pregnancy as an emotional crisis. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.
Option D: Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. Heart failure incidence has remained stable over the past decades, with more than 650,000 new cases of heart failure cases diagnosed annually, especially for individuals greater than 65 years of age. Because prevalence is greater in this age group, heart failure prevalence is expected to worsen in the near future.