Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarction when that can be observed, and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
***Each question must be answered individually. Not in an essay format.
Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; etc.
Cardiovascular case study
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Cardiovascular case study
Introduction
Cardiovascular diseases are associated with damages to the heart and blood vessels. It is one of the main causes of death and disability around the world. The case study presents a 53-year-old white man named Mr. W.G. He experienced chest discomfort that intensifies to crushing sensation within the sternal area with pain spreading to the neck and lower jaw regions. He was transported to the emergency department for medical checkups. The paper uses this case study to answer all the questions required for the completion of this assignment.
For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors
Patients with coronary artery disease and myocardial infarct can have two categories of risk factors such as modifiable and non-modifiable risk factors. Non-modifiable risk factors are those that patients, doctors, and family members can do nothing about; they cannot be changed (Tubaro et al., 2021). Non-modifiable risk factors include family history, age, gender, and genetic factors. Older adults have an increased risk of developing heart diseases. Women have higher mortality and worse prognosis after acute cardiovascular events. People who have a family history of cardiovascular diseases are at greater risk (Tubaro et al., 2021). People who have certain genetic factors have an increased risk of getting cardiovascular diseases.
Non-modifiable risk factors include smoking, lack of physical activity, high LDL and triglyceride levels, and hypertension. Excessive smoking leads to the formation of plaque in blood vessels leading to cardiovascular diseases (Tubaro et al., 2021). Lack of physical activity is associated with both coronary artery disease and myocardial infarct (Sawyer & Vasan, 2018). Elevated triglyceride levels and dense, small LDL particles act as predisposing risk factors for myocardial infarct.
What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
Electrocardiogram (EKG) is used to detect the abnormal heart rhythm due to narrowed or blocked arteries. Mr. W.G is likely to experience some abnormalities in heart rhythm, which is evidence of a possible heart attack (Sawyer & Vasan, 2018). If the patient has abnormal EKG, findings may include chest pain or discomfort, a moderate rise in temperature, nausea, shortness of breath, and heart palpitations. Symptoms of angina can be mild, making the patient feel discomfort or heaviness in the chest. Also, it can be severe like crushing pain (Tubaro et al., 2021). These are some of the symptoms of heart attack that the patient is most likely to experience.
Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
The best laboratory test to confirm acute myocardial infarct is the test for levels of troponin in the blood. Troponin is a protein found in the heart muscles but released in the blood when heart muscles are damaged during a heart attack (Tubaro et al., 2021). The normal range for troponin is between 0 and 0.04 ng/mL Troponin test is an effective confirmatory test for heart attack. Troponin is the most commonly used biomarker to differentiate heart attack from stable angina and unstable angina is Troponin (Tubaro et al., 2021). The test is usually ordered in the emergency room when the patient reports chest pain and other symptoms of a heart attack.
How do you explain that Mr. W. G’s temperature has increased after his Myocardial Infarction when that can be observed, and for how long? Base your answer on the pathophysiology of the event
Fever is a common symptom for patients who have suffered an acute myocardial infarction. The rise in temperature experienced by Mr. W.G. is associated with the pathophysiology of the illness. There is always increased body temperature 4 to 8 hours after experiencing a myocardial infarction (Sawyer & Vasan, 2018). The rise in body temperature is an unspecific response to myocardial damage because it leads to elevated serum levels of myocardial enzymes and C‐reactive protein.
Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer
The pain experienced by the patient is due to heavy pressure when the heart pumps faster than it should. Patients who experience myocardial infarction often have narrowed blood vessels due to the buildup of plaque (Sawyer & Vasan, 2018). Therefore, the heart gets insufficient oxygen and blood supply. The narrowing of blood vessels leads to ischemia and angina as the heart pumps faster to balance the demand and supply of oxygen and blood in the heart. This is the reason for the pain the patient experienced.
Conclusion
Cardiovascular conditions are among the leading causes of death around the world. Heart attack and coronary heart disease are common cardiovascular conditions. Categories of risk factors for these conditions are modifiable and non-modifiable risk factors. Troponin tests are used as a confirmatory test for a heart attack.
References
Sawyer, D. B., & Vasan, R. S. (2018). Encyclopedia of cardiovascular research and medicine. Elsevier.
Tubaro, M., Vranckx, P., Price, S., Vrints, C., & European Society of Cardiology. (2021). The ESC textbook of intensive and acute cardiovascular care. Oxford University Press.