A 55-year-old man presents to the clinic with complaints of chest pain. He states that for the past.

A 55-year-old man presents to the clinic with complaints of
chest pain. He states that for the past 5 months he has noted intermittent
substernal chest pressure radiating to the left arm. The pain occurs primarily
when exercising vigorously and is relieved with rest. He denies associated
shortness of breath, nausea, vomiting, or diaphoresis. He has a medical history
significant for hypertension and hyperlipidemia. He is taking atenolol for his
high blood pressure and is eating a low-cholesterol diet. His family history is
notable for a father who died of myocardial infarction at age 56
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A 55-year-old man presents to the clinic with complaints of
chest pain. He states that for the past 5 months he has noted intermittent
substernal chest pressure radiating to the left arm. The pain occurs primarily
when exercising vigorously and is relieved with rest. He denies associated
shortness of breath, nausea, vomiting, or diaphoresis. He has a medical history
significant for hypertension and hyperlipidemia. He is taking atenolol for his
high blood pressure and is eating a low-cholesterol diet. His family history is
notable for a father who died of myocardial infarction at age 56 years. He has
a 50-pack-year smoking history and is currently trying to quit. His physical
examination is within normal limits with the exception of his blood pressure,
which is 145/95 mm Hg, with a heart rate of 75 bpm.

Questions

A. What is the likely diagnosis? How would you classify his
diagnosis clinically?

B. What are the most common causes of this disease? Which is
the most likely in this patient?

C. What are this patient’s risk factors for coronary artery
disease?

D. What is the hypothesized mechanism by which
atherosclerotic plaques form?

E. What is the pathogenetic mechanism by which plaque
formation results in the symptoms mentioned?

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