NR 603 Cardiovascular Case Study

Question 1

The leads that demonstrate ST depression include leads V4-V6 (Namdar et al., 2018).

Question 2

According to the ACA guidelines for 2017, the patient has hypertension stage two. This is attributed to the fact that the systolic blood pressure is more than 140 mm Hg while diastolic blood pressure is more than 90 mm Hg. The recommended treatment for the patient’s condition is the use of interventions that include lifestyle modification and initiation of antihypertensive therapy. This is because of her presenting symptoms and daytime ABPM being more than 130/80 mm Hg (Whelton et al., 2017). According to the JNC 8 guidelines, the patient is hypertensive. This is attributed to her being less than 60 years with blood pressure more than 140/90 mm Hg. Based on their classification, the patient should be initiated on anti-hypertensive treatment regardless of age due to be being diabetic (Armstrong, 2014).

Question 3

The primary diagnosis causing the patient’s chest pain is acute coronary syndrome. This is based on her presenting symptoms such as shortness of breath, discomfort radiating to the shoulders, and her back. There is also ST depression in leads V4 to V6. These symptoms arise when exercising and subside when the patient is at rest (Handberg & Anderson, 2017). These symptoms align with those of acute coronary syndrome.

Question 4

The other secondary that should be addressed include obesity, metabolic syndrome, and elevated level of A1C and hyperlipidemia. The increase in the patient’s waist circumference indicated metabolic syndrome. Elevation of her A1C level results in the diagnosis of pre-diabetes. The elevation of her blood pressure also makes her hypertensive. The patients BMI is also high, which indicates obesity.

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Question 5

The patient needs to be initiated on anti-hypertensive medications and initiation of lifestyle and behavioral modifications to manage the patient’s health problems. According to JNC 8 hypertension guidelines, the patient should be initiated thiazide, ARB (angiotensin receptor blockers), ACEI (angiotensin converting enzyme inhibitors), or CCB (calcium channel blockers) alone or in combination. The plan of management should be discussed with a cardiologist since the patient is at a risk of developing heart failure. The patient should be referred to tobacco cessation clinic to assist the patient in addressing her tobacco dependence problem. Follow-up should be undertaken after four weeks to determine whether the symptoms have resolved with the prescribed management. The education that should be shared with the patient include smoke cessation, drug adherence, eating healthy, reducing sodium in diet, and engaging in moderate physical activity 3-4 days a week lasting for an average of 40 minutes in every session. The drugs of choice for this patient include angiotensin converting enzyme inhibitors alone or in combination with either calcium channel blockers or a diuretic. The drugs will inhibit over excitation of the heart muscles alongside fluid loss through the renal system with the use of diuretics (Rodriguez-Saldana, 2019). The patient should be encouraged to take diets preferred in her culture that has low fat and sodium.

References

Armstrong, C. (2014). JNC8 guidelines for the management of hypertension in adults. American family physician, 90(7), 503-504.

Handberg, E., & Anderson, R. D. (2017). Acute Coronary Syndrome: Urgent and Follow-up Care (Vol. 3). Cardiotext Publishing.

Namdar, H., Imani, L., Ghaffari, S., Aslanabadi, N., Reshadati, N., Samani, Z., … & Separham, A. (2018). ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention. Interventional Medicine and Applied Science, 10(4), 191-197.

Rodriguez-Saldana, J. (Ed.). (2019). The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues. Springer.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., … & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.

NR 603 Cardiovascular Case Study