ST is a 57-year-old man who presents

ST is a 57-year-old man who presents to the doctor with angina pectoris and hypertension. History and physical examination Both ST’s parents had hypertension although neither parent is still alive. At home, ST primarily eats fatty foods like sausages and fried foods like chips. But he admits to mostly having takeaways. He enjoys a six-pack of beer on weekdays and over 12 beers on weekend days. ST does not engage in much physical activity. He is overweight (BMI 29.5) and has sleep apnoea on most nights. He complains that he is always tired and is stressed this year because his business is not doing well. ST enjoys chewing tobacco “because it doesn’t cause health problems”. His angina attacks are precipitated by overactivity and excitement. On at least two occasions, ST has had an angina attack at football matches when his team was narrowly beaten. When first diagnosed five years ago, the attacks were easily relieved with sublingual doses of the organic nitrate glyceryl trinitrate. More recently, it has taken longer and more doses of medicine to relieve an attack. He is taking a calcium channel blocker nifedipine and the thiazide diuretic hydrochlorothiazide for his hypertension. He also requires an oral potassium supplement. His blood cholesterol level is moderately high and his HDL: LDL ratio is low. after failed attempts to modify his diet, ST’s doctor has just started him on a statin. At the next football match, ST has a severe angina attack where the pain is intense. it is not relieved by glyceryl trinitrate and ST thinks he is going to die. He is pale, grey, sweaty, and dyspnoeic. He is taken to the hospital by ambulance for treatment. -Sublingual doses of the organic nitrate glyceryl trinitrate are said to ‘dilate the vasculature’. Does this medication work by dilating the coronary artery of those with atherosclerotic plaques? Explain why or why not and explain how it works. ( 100 words) -Explain the mechanisms of action of nifedipine in decreasing blood pressure. ( 80 words)- -Briefly describe the main mechanism of action of the statins. What are the three most important adverse effects? (one sentence plus three dot points can attain full credit. Decide the most important side effects and do not include more than three.) SCIENCE

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