Cardiovascular Case Study “Tight Chest MR M
59 Yrs iHUMAN
Cardiovascular case study
Mr. M is a 59-year-old male who presents to the emergency
... [Show More] 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
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Cardiovascular Case Study “Tight Chest MR M
59 Yrs iHUMAN
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
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Cardiovascular Case Study “Tight Chest MR M
59 Y [Show Less]