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Cardiovascular Case Study
PJ is a sixty-seven-year-old man with a long history of stable angina. He is treated with nitroglycerin tablets as needed for chest pain. He has mild hypertension, which is well controlled by diet and an angiotensin-converting enzyme (ACE) inhibitor. PJ has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets.
PJ’s symptoms are consistent with what diagnosis? What education would you provide to PJ?
One morning, at about 4:00 a.m., PJ is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He is diaphoretic and pale. His wife calls for emergency assistance, and PJ is transported to the local emergency department. Upon admission, the electrocardiogram (ECG) shows significant ST-segment elevation.
According to the ECG findings, what is the differential diagnosis? At the time of admission, a blood sample is taken to determine whether PJ has suffered an MI. Which laboratory findings would indicate MI? Describe the pathophysiological responses occurring in the body during an MI.
I think he has a build up of plague which turns builds up lactic acid.
| Subject | Nursing | Pages | 4 | Style | APA |
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Answer
Cardiovascular Disease Case Study
PJ’s signs and symptoms show clinical features of angina pectoris. The features particularly point to stable angina whose symptoms are mitigated by rest or nitroglycerin administration (Agewall, 2014). The diagnosis is made based on the medical history of PJ and the current clinical presentations.
Following the diagnosis with angina pectoris, PJ needs appropriate nursing education to improve his quality of life. I would educate PJ to improve the integrity of his cardiovascular system through various interventions. PJ should ensure he conducts regular exercises to reduce the already existing mild hypertension. Exercise is an excellent long-term treatment for angina (Agewall, 2014). PJ should also continue with the medications of ACE and nitroglycerine to improve his cardiovascular functions and reduce pain (Agewall, 2014). Most importantly, PJ should adjust his diet to consist of fewer fats and cholesterols. He should go for blood tests for elevated levels of cholesterols that increase risks for hypertension and diabetes (Agewall, 2014).
The most common cause of ST segment elevation is ST elevation myocardial infarction (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). Myocardial infarctions most commonly cause either elevation or depression of the ST segment (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). Therefore, basing the diagnosis on the ST elevation, PJ experienced an acute myocardial infarction. However, confirmatory tests must be done in the laboratory before initiation of treatment. The main confirmatory test would be the investigation of the cardiac markers in the blood stream (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). The results would show elevated levels of creatine kinase and cardiac troponins I and T to confirm myocardial infarction (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012).
Pathophysiological phenomena occur in the blood, vessel endothelium, and myocardium (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). Atherosclerotic plaque is disrupted in the coronary artery, and a clotting cascade is initiated (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). The blockade minimizes blood flow to the myocardium and consequently leading to cell death. Tissue damage also takes place as apoptosis (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012). Therefore, cardiac output and blood pressure falls due to the weakened muscles. Inflammation cascade also elevates the levels of C - reactive protein in the blood (Steg, James, Atar, Badano, Lundqvist, Borger, & Fox, 2012).
References
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Agewall, S. (2014). New guidelines for diagnosis and management of stable angina pectoris. Recommendations from the European Society of Cardiology. Läkartidningen, 111(15), 680. Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., Borger, M. A., ... & Fox, K. A. (2012). ESC Guidelines for management of the acute myocardial infarction in patients presenting with ST-segment elevation. European heart journal, ehs215.
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