Download Case Study: Coronary Artery Disease in a 63-year-old Male Patient J.G. and more Exams Nursing in PDF only on Docsity! BIO 188 CASE STUDY CORONARY ARTERY DISEASE (REAL PATIENT) J.G. is a 63-year-old Caucasian male who experienced chest pains for about an hour while relaxing at home and decided to go to the emergency room. He was frightened because he knew that he didn’t take very good care of himself. He has smoked about 1 ½ packs of cigarettes per day for 45 years and dines on fast food for lunch daily. He had a sense that his chest pains were serious. He is 5’10” tall and weighs 260 lbs. At the ER the doctor ordered an EKG that was abnormal. Chest x-ray was normal. Blood pressure was 140/95. Blood lipid profile was abnormal. LDL cholesterol was 180 mg/dL; HDL cholesterol was 25 mg/dL and the total cholesterol /HDL cholesterol ratio was greater than 7.0. The chest pain started to decrease in the ER after the patient was given Demerol (for anxiety). Because of the seriousness of the complaint it was decided that the patient should be admitted to the hospital for further workup and observation. The patient was administered nitroglycerine (for chest pain), and heparin (a blood thinner). The patient underwent a nuclear cardiology study to evaluate presence of heart muscle damage since the abnormal EKG suggested a heart attack. Results of the study indicate that the patient had sustained a mild heart attack. A coronary angiogram was performed to determine where vascular blockages occurred in the heart. The final diagnosis was a heart attack precipitated by coronary artery disease (CAD). The angiography procedure revealed that a single blood vessel was blocked. During the angiography study the consulting cardiologist determined that angioplasty with stenting of the mid right coronary artery should be performed to restore blood flow to the heart. This procedure involves inserting a catheter into the femoral artery in the groin and threading it up to the heart. The catheter has a balloon at its tip. Using an x-ray guidance system the cardiologist carefully inserts the tip of the catheter into the blocked coronary artery and expands the balloon to force the artery open. Another catheter is used to place a stent (a small metal-like sleeve) at the site. The patient tolerated the procedure well and was discharged from the hospital three days later with instructions not to lift anything over 10 lbs. for four weeks and to stop smoking. The patient was in good condition at time of discharge. He was provided prescriptions for Lipitor (to control high cholesterol) and Tenoretic (for control of blood pressure).The patient was instructed to reduce dietary fat and to return to the cardiologist’s office in three weeks for further evaluation. Discussion Questions 1. What is a heart attack? 2. What are risk factors for coronary artery disease (CAD)? Did J.G. have any risk factors? 3. What is the purpose of the stent? Risk factors: A number of risk factors have been identified for cardiovascular diseases including coronary artery disease: smoking, sedentary behavior, obesity, high blood pressure, high serum cholesterol, and diabetes. In addition certain dietary factors (e.g. low vegetable or fruit intake), excessive alcohol consumption and unmanaged stress may also contribute to risk. The aging of the population will undoubtedly result in an increased incidence of chronic diseases, including coronary artery disease, heart failure and stroke. The U.S. Census estimates that there will be 40 million Americans age 65 and older in 2010. There’s been an alarming increase in the prevalence of obesity and diabetes. Related complications including hypertension and high blood lipids have also increased. A general lack of concern in cardiovascular disease risk factors by the younger generations will continue to fuel the cardiovascular epidemic for years to come. Diagnosis: Tests for coronary artery disease include EKG (resting and under controlled exercise), stress echocardiogram, nuclear cardiogram and cardiac angiography. The definitive test is the coronary angiogram which images actual blockages in heart blood vessels. Treatment: Coronary artery bypass grafting (CABG), angioplasty (with or without stent), arthrectomy, control of diet, regular exercise, smoking cessation, anti-hypertensive medications, beta blockers (e.g. Tenormin) to quiet the heart, statins (e.g., Zocor or Lipitor) and other drugs for the control of blood lipids.
