NUR 502 Cardiovascular Risk Factor and Heart Attacks Case Study
AP2 Discussion 2b
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.
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.
Unlike non-modifiable risk factors for acute myocardial infarction, which cannot be controlled, modified risk factors such as high blood cholesterol, depression, obesity, and physical inactivity can be reduced or controlled with altered behavior. Non-modifiable risk factors for patients with acute myocardial infarction include race, gender, age, and genetics (Anderson & Morrow, 2017).
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?
Even though the chest pain was not relieved by 3 SL NTG tablets, the severity of the pain eased from 9/10 to 7/10. Hence, slight ST-segment deviations would be observed on the electrocardiogram (EKG). Also, the heart’s electrical activity of patients with acute myocardial infarction is high due to the blockage of one or more coronary arteries. For this reason, a T wave inversion would be observed on the EKG.
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?
Cardiac Troponin 1 is the most effective serological laboratory test that can be used to confirm a myocardial infarction. Lu et al. (2015) reveal that Troponin 1 is a better cardiac marker as it is more sensitive and specific than Troponin T. Unlike troponin T, which is less specific, Troponin 1 is more specific of risks of composite cardiovascular and coronary heart attacks such as myocardial infarct.
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
According to Lu et al. (2015), heart exhaustion is among the causes of fever. Within 30 minutes, when Mr. W.G. was rushed to the nearest hospital, a coronary artery blockage occurred, causing difficulties in blood pumping. Difficulties in the pumping of blood result in heat exhaustion. Heart exhaustion triggered fever that increased by more than 1oC.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Myocardial infarction is caused by an abrupt blockage of blood from entering the heart muscle (Anderson & Morrow, 2017). This blockage causes tissue damage. Hence, the pain was experienced due to tissue damage.
References
Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064.
Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: Symptoms and treatments. Cell biochemistry and biophysics, pp. 72, 865–867.