weekWEEK4
PJ’s symptoms are consistent with what diagnosis? What education would you provide to PJ?
PJ’s symptoms are consistent with stable angina also known as angina pectoris (McCance and Huether, 2014). Sta
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weekWEEK4
PJ’s symptoms are consistent with what diagnosis? What education would you provide to PJ?
PJ’s symptoms are consistent with stable angina also known as angina pectoris (McCance and Huether, 2014). Stable angina is caused by stiffening of the walls of the coronary arteries which do not allow the arteries to dilate during periods of exertion. This leads to decreased blood flow to the myocardium which causes anaerobic respiration and a buildup of lactic acid. The buildup of lactic acid is what causes the classic substernal chest pain (McCance and Huether, 2014). Once myocardial oxygen demand decreases by the patient resting, the pain subsides as the heart is now receiving adequate oxygen and no permanent damage is done (McCance and Huether, 2014). Nitroglycerin helps alleviate the symptoms of stable angina. This works by nitroglycerin being metabolized into nitric oxide which is a potent vascular smooth muscle relaxer (Boden, Finn, Patel, Peacock, and Thadani, 2012). This causes the coronary arteries to dilate which increases the amount of oxygenated blood that the heart receives.
Nitroglycerin is not specific to coronary arteries, it also dilates the peripheral veins which reduces preload and afterload which in turn reduces the workload of the heart (Boden, Finn, Patel, Peacock, and Thadani, 2012).
The most important education that I would give to PJ is about cardiac rehabilitation. The goal of cardiac rehabilitation is to slow the progression of coronary artery disease by reducing the impact of modifiable risk factors for angina which include smoking cessation, weight control, lipid management, diabetes management, and diet and nutrition counseling (Boden, Finn, Patel, Peacock, and Thadani, 2012). If PJ attends cardiac rehab and reduces his modifiable risk factors as well as being compliant with
his prescribed medications, PJ’s quality of life will increase by being able to be more active without getting chest pain.
According to the ECG findings, what is the differential diagnosis?
According to the ECG findings, PJ has suffered an acute ST elevation myocardial infarction also known as a STEMI (McCance and Huether, 2014). This occurs when a plaque buildup in a coronary artery ruptures which then activates the clotting cascade and completely blocks blood flow to certain areas of the heart. STEMI patients are considered true medical emergencies and require immediate intervention in a cardiac catheterization laboratory to disrupt the clot and return blood flow to the heart. Time is tissue and getting the patient to the cath lab is top priority.
Which laboratory findings would indicate MI?
The most sensitive laboratory finding during an MI is an elevated troponin (McCance and Huether, 2014). However, troponin values take approximately two to four hours after symptom onset to become elevated and is not a good indicator of cardiac ischemia during an acute STEMI (McCance and Huether, 2014). Other laboratory tests that are not as specific as troponin include creatine kinase (CK) and lactic dehydrogenase (LDH). Elevations in C-reactive proteins also occur due to the inflammatory response that occurs during a STEMI (McCance and Huether, 2014).
Describe the pathophysiological responses occurring in the body during an MI.
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