(1 point). Listen.
Which of the following patients is at the highest risk for silent myocardial ischemia caused by dysfunction of the autonomic nerves?

Choice A rationale:

Anemia is not directly associated with endothelial injury in atherosclerosis. While anemia can lead to reduced oxygen delivery to tissues, it is not a primary factor in endothelial injury. Atherosclerosis is primarily linked to risk factors like smoking, hypertension, and hyperlipidemia.

Choice B rationale:

Smoking is a significant risk factor for atherosclerosis and can cause endothelial injury. Smoking introduces harmful chemicals into the bloodstream, leading to inflammation and damage to the inner lining of blood vessels (endothelium). This damage can promote the development of atherosclerotic plaques.

Choice C rationale:

Blood pressure of 110/70 is within the normal range, and while hypertension is a risk factor for atherosclerosis, this specific blood pressure measurement does not indicate endothelial injury.

Choice D rationale:

A history of asthma is not a direct risk factor for atherosclerosis or endothelial injury. While chronic inflammatory conditions can contribute to cardiovascular disease, asthma alone is not typically associated with atherosclerosis.

Choice A rationale:

A patient with Alzheimer's disease is at risk for various health complications, but the question specifically asks about the risk of silent myocardial ischemia caused by dysfunction of the autonomic nerves. While Alzheimer's disease may lead to autonomic nervous system dysfunction, diabetes mellitus is a more well-established risk factor for autonomic neuropathy, which can result in silent myocardial ischemia.

Choice B rationale:

Diabetes mellitus is a known risk factor for autonomic neuropathy, which can result in silent myocardial ischemia. Autonomic neuropathy affects the nerves that control vital functions such as heart rate, blood pressure, and digestion. This can lead to silent myocardial ischemia, where the patient may not feel the typical chest pain (angina) associated with reduced blood flow to the heart. Therefore, patients with diabetes are at the highest risk for this complication.

Choice C rationale:

Hypertension, while a risk factor for heart disease, is not directly linked to autonomic neuropathy and silent myocardial ischemia. Hypertension can lead to other cardiovascular complications but is not the primary risk factor for this specific complication mentioned in the question.

Choice D rationale:

Emphysema is primarily a lung condition and is not directly related to autonomic neuropathy or the risk of silent myocardial ischemia. While patients with emphysema may have increased cardiovascular risk due to chronic hypoxia, diabetes mellitus is a more significant risk factor for autonomic neuropathy and its associated complications, such as silent myocardial ischemia.