Cardiovascular case study

Madonna University Saturday September 21, 2019 Cardiovascular case study Mr. M is a 59-year-old male who presents to the emergency department with complains of tight chest pressure, jaw pain and left arm numbness and tingling. He also had shortness of breath after lifting several boxes in his garage approximately 2 hours ago. Mr. M thinks that his heart is skipping beats. His medical history is significant for hypertension hyperlipidemia is a cigarette smoker and leads a sedentary life style. On examination, his B/P is 155/95 and heart rate is 55 beats/min and regular, and his lungs are clear to auscultation. An electrocardiogram shows bradycardia with an increased PR interval and ST-segment elevation in multiple leads including the anterior leads, V3, V4. The patient also reports becoming diaphoretic during the event however denies nausea, vomiting, dizziness, syncope or near syncope. He also reports never experiencing these symptoms in the past. Mr. M current medication include Amlodipine 10mg daily and Atorvastatin 20mg daily. He has smoked 1 PPD for 25 years, consumes 2 beers per week, denies drug use. Both of his parents passed way in their early 60s from coronary artery disease. His father died at 61 yoa from an MI and mother at 63 yoa from the complications of congestive heart failure. Given the above information answer the questions below. Questions 1. What is the most likely diagnosis for this patient? a. According to the information given above, the most likely diagnosis would be a Myocardial infarction. An MI is an area of the myocardium that is permanently destroyed. This is caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus (a blood clot formed within a blood vessel). There are various descriptions used to further identify the type of MI present. In this case, Mr. M’s electrocardiogram indicated an ST-segment elevation further indicates that this is a ST-segment elevation MI (STEMI) (Honan, 420). 2. What are the most common causes of this disease? Which is the most likely in this patient? a. A myocardial infarction can have many underlying causes which includes, when a spasm of the coronary artery leads to constriction and shutting down of blood flow to an area of the heart muscle this can occur due to the use of tobacco and in Mr. M’s case he indicated he has smoked 1 PPD for 25 years which could be a cause that lead to his diagnosis of an MI. Another common cause for this disease is hyperlipidemia which is an elevated cholesterol level, this can cause the coronary artery to become narrow and reduce blood flow to heart muscle also the elevated cholesterol levels can build up in the walls of the arteries leading to atherosclerosis further leading to myocardial infarction. Mr. M’s history did present with hyperlipidemia. Hypertension (at least 130/85 mm Hg) which is also indicated on Mr. M’s history is another common cause. This high blood pressure This study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 causes excess strain that results in damage that causes the arteries to slowly become narrow and further reduce blood flow to the heart (Honan, 422). 3. What are this patient’s risk factors for coronary artery disease? a. Risk factors are further categorized as modifiable and nonmodifiable. Nonmodifiable risk factors include age (men over 45 years old) and Mr. M is a 59-year-old male. Gender as well, men are at greater risk and in his case this increases his risk. Family history of first-degree relative with premature diagnosis of heart disease which is another nonmodifiable risk factor, both of his parents passed away in their early 60s from coronary artery disease. Modifiable risk factors include a history of smoking, hypertension, hyperlipidemia, and a sedentary lifestyle (physical inactivity). Mr. M presents with all the modifiable risk factors and nonmodifiable risk factors which have put him at a greater risk for coronary artery disease. Modifiable risk factors are measures that can be taken to change/lower his risk of developing the disease or managing this event from reoccurring (Honan, 422). 4. What laboratory tests would you as the nurse expect to be ordered? a. Laboratory tests that would be ordered are known as cardiac biomarkers which are used to diagnose an MI. Troponin analysis produces faster results and earlier diagnosis. Also, another order put into place would be an ECG which could be done as soon as the patient reports symptoms of pain. The location, resolution and evolution of an MI can be identified with an ECG and also this can help identify the type of MI it is. In this case the presence of an ST-segment elevation is a significant finding. An echocardiogram is used to evaluate ventricular function and may be used to assist in diagnosing an MI, especially when the ECG is nondiagnostic. This can detect hypokinetic and akinetic wall motion, determine ejection fraction and also assess valvular function (Honan, 425). 5. As the nurse caring for this patient the family is asking what the treatment plan is for Mr. M. Provide an explanation of what you would tell the family regarding the procedure used during a myocardial infarction? a. The goal of treatment during the management of a myocardial infarction is to lessen myocardial damage, save myocardial function, and prevent further complications associated with the disease. Therefore, the family needs to be involved in the course of action that will be taken, the diagnostics studies used and the results of the diagnostic studies and also the medications that will be involved in the treatment process and furthermore education process that should be put in place to manage the disease. First measures that need to implemented is to get an ECG started within the 10 minutes of onset of when the patient is admitted to the hospital. The family should understand the importance of this procedure and how it will help us identify further treatment measures. Lab blood specimen of cardiac biomarkers (specifically troponin) should be assessed as well as this is crucial. The family will be informed on the importance of this cardiac This study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 biomarker in the identification of an MI. Medication regimen that will most likely be implemented are nitroglycerin which is first-line treatment for acute MI, morphine which is used to decrease the pain and anxiety associated with a myocardial event, aspirin (162 mg or 325 mg) or clopidegrel which will prevent platelet aggregation and help prevent a recurrent MI by slowing/ decreasing blood clot formation. Beta-blockers are given as initial treatment during hospitalization which reduce the incidence of recurrent angina, infarction and cardiac mortality. The patient and the family as well will be educated on the importance of being compliant with the medication regimen as this is crucial in managing this event. Supplemental oxygen which will assist in reperfusion, this is essential for the patient and family to be involved in the treatment plan, so it can decrease anxiety and concerns regarding this disease (Honan, 429-430). 6. Upon discharge what other medications do you anticipate Mr. M being prescribed and what discharge teaching would you include to the patient and family? a. The medication that Mr. M would most likely be discharged home with are Clopidogrel (Plavix) and Ticagrelor which are usually the recommended treatment for medical management of an MI this is given in combination with Aspirin. Beta-blockers are also recommended during hospitalization after an MI event they reduce the incidence of recurrent angina, infarction, and cardiac mortality. Beta- adrenergic blocking agents such as Metoprolol (Lopressor, Toprol) reduce myocardial oxygen consumption which results in a decreased heart rate, slowed conduction of impulses through the conduction system as well as decreased blood pressure which in Mr. M’s case will be very beneficial. The Clopidogrel is given to prevent platelet aggregation and subsequent thrombosis which impedes blood flow. This also applies to the use of Ticagrelor (Honan,