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Case Study For Coronary Artery Assignment Paper

Case Study For Coronary Artery Assignment Paper

Case Studies

Myocardial infarction: a disease that is brought about by reduced or complete cessation of blood flow to a portion of the myocardium. The patient presented with chest tightness, has a history of smoking, alcohol consumption and a familial history of myocardial infarction.  On physical examination, patient is obese and has added heart sounds. Coronary artery occlusion leads to myocardium deprivation of oxygen, which if prolonged, leads to cell death and necrosis. Risk factors can either be; modifiable and non-modifiable according to INTERHEART. Modifiable risk factors comprises; hypertension, diabetes mellitus, smoking, dyslipidaemia, abdominal obesity physical inactivity, alcohol consumption and psychosocial factors such as depression, financial stress and loss of a loved one. Non-modifiable risk factors include; male gender, advanced age and, familial history of MI (Ojha & Dhamoon, 2022)Case Study For Coronary Artery Assignment Paper. the clinical manifestation includes; chest pain, mandibular or upper extremity lain an epigastric pain. Other signs include; light-headedness, palpitations, fatigue, sweating, abdominal pain, nausea and dyspnoea.

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Hypertension: a disease that presents with consistently elevated blood pressure of >130mmHg systolic and >80mmHg diastolic in the systemic arteries. It is a major cause of end organ damage such as; cardiovascular, cognitive impairment, liver disease and chronic kidney disease. According to Arshad Muhammad Iqbal & Jamal, (2022)Case Study For Coronary Artery Assignment Paper, majority of patients are asymptomatic and high blood pressure is an incidental finding where as some of the patients present with symptoms of end-organ damage such as; chest pain, acute pulmonary oedema, stroke-like symptoms and shortness of breath. The patient presented with headache and light headedness and on examination the blood pressure was elevated. The patient was also at risk of the disease due to the smoking history, alcohol consumption, loss of a loved one and is obese.

Generalized anxiety disorder: a disorder that causes constant worry, fear and a constant feeling of being overwhelmed. There is history of loss of a child two months ago. According to Munir S;Takov V, (2022),the aetiology includes; stress, substance abuse, environmental factors and comorbidities such as depression. Patient often present somatic symptoms more than psychological symptoms. They include; palpitations, headache, easy fatigability, dizziness, shortness of breath and others.

Lab investigations

  • Complete blood count: check the white cell and haemoglobin level to rule out infection or anaemia.
  • Lipid profile: helps in measurement of different types of fat to assess for dyslipidemia.
  • Cardiac enzymes: act as bio markers to show evidence of heart muscle damage. They include Troponin T and Troponin I and are more specific to a heart attack. Others include creatinine phosphokinase and myoglobin.
  • BNP: helps in measuring the cardiac function and used in diagnosing heart failure.
  • CMP: a group of tests that measures the current status of the body’s metabolism. It comprises of the blood sugar levels, electrolytes, fluids, as well as the liver and kidney function.
  • Thyroid function tests: assess for thyroid abnormalities.
  • HBA1C: monitor blood sugar control over the past three months.
  • Liver function tests: check the liver enzymes (ALT, ALP, AST) for any signs of liver damage.
  • UECS: evaluate the kidney function and rule out electrolyte imbalance.
  • ECG: monitors the heart electrical activity. Helps in identifying abnormal heart rhythms. In this case it showed a normal sinus rhythm with no ST changes.
  • Chest x-ray: look at the heart, lungs, trachea and surrounding structures for any pathology. Rule out cardiomegaly a sign of heart failure.
  • Echocardiogram: check the anatomy and physiological functioning of the heart muscle Case Study For Coronary Artery Assignment Paper

 

If all the laboratory tests would come back normal except mild hyperlipidaemia, the most probable diagnosis would be;

Coronary artery disease: results from inadequate supply of oxygen and blood to the myocardium often as a result of occlusion of the coronary artery leading to demand-supply mismatch of oxygen. The causative agents are classified as either modifiable or non-modifiable. Modifiable agents include; obesity, smoking, high lipid levels and psychosocial variables (Braun et al., 2018)Case Study For Coronary Artery Assignment Paper. On the other hand, non-modifiable factors comprises; age, gender, family history and genetic predisposition. The disease can present as acute coronary syndrome or stable ischaemic heart disease and if not well controlled, it can complicate to congestive heart failure.

Plan of treatment

  • Sublingual nitro-glycerine 2.5mg TDS for 1/12

Nitrates relax the vascular smooth muscles resulting to dilatation of vessels thus decreasing the preload and in turn reduce the myocardial oxygen demand thus providing relief of the chest symptoms.

  • PO atorvastatin 40mg OD for 1/12

Statin therapy helps in reduction of cholesterol level thus reducing the incidents of myocardial infarction and stroke.

  • PO enalapril 5mg OD for 1/12

Essential in blood pressure control.

  • PO aspirin 75mg OD for 1/12

Reduces the risk of thrombi formation.

Follow up care

  • Advise on follow up after one week to assess the progress.
  • Encourage blood pressure and blood glucose monitoring and recording every day.

Referrals

  • Refer the patient for psychologist review. The patient has a history of recent loss of a loved one that may be contributing to the symptoms. Research studies have shown that emotional stress and psychosocial factors often influence the onset and course of ischaemic heart disease.
  • Refer for nutritional review to guide on the recommended diet.
  • Refer for cardiology review. Case Study For Coronary Artery Assignment Paper

The plan of treatment would not be different if the patient was female. This is because there is no gender-specific recommendation.

Education

  • Advise patient on smoking cessation. According to Braun et al. (2018), cigarrete smoking is a major risk factor in development of cardiovascular diseases. Smoking has post-thrombotic effect which has a strong relation with myocardial infarction and atherosclerosis.
  • Eat a low salt diet.
  • Advise on dietary, alcohol and weight control. Encourage dietary intake of that is low in saturated fats with plenty of vegetables, fruits and whole grain products.
  • Encourage compliance with medications.

Case study 2

Impetigo: a skin infection that mainly affects the superficial layer of the dermis.  It mostly affects the paediatric population especially between 2-5 years. The patient presented with a rash that progressed to fluid-filled vesicles that later turned to a scab with honey-coloured crusting. There is also history of a similar presentation in the family. According to Nardi & Schaefer, (2021), the disease is caused by gram positive bacteria and is highly contagious. The clinical manifestation includes; erythematous plague with a yellow crust and maybe painful or itchy. It typically affects the face but can also occur in any other part of the body that has a laceration, abrasion, trauma or insect bite.

Scabies: a highly contagious condition that results from infestation of Sarcoptes scabiei mite which burrows within the skin causing severe itching especially at night. Skin to skin contact increases the chances of transmission (Gilson & Crane, 2022)Case Study For Coronary Artery Assignment Paper. Patient presented with rashes that are associated with severe itching.Scabies present with hyperkeratotic plagues that can be localized or diffuse. Secondary infections often ensue following tunnelling by the mites.

Herpes simplex virus: an infection caused by herpes simplex type 1 and 2 that produces recurrent lesions (James et al., 2020). It typically present with mucocutaneous manifestation such as; herpetic keratitis, herpes genitalis, gingivostomatitis and dermal whitlows.

Lab investigations

  • Complete blood count: check the white blood cell count for evidence of infection.
  • Swab for microscopy, culture and sensitivity: identify the specific causative organism and the drug that can be used in treatment.

Diagnosis

Based on the history and physical examination findings, the most likely diagnosis is impetigo. According to (Nardi & Schaefer, 2021), impetigo often starts as a pustule or vesicles which coalesce and rupture to form a purulent exudate with a characteristic honey-coloured crust. There is also a history of contact with a person with the same clinical presentation thus further supporting the diagnosis.

Plan of treatment

Use of topical antibiotics or in conjunction with systemic antibiotic is used in treatment of impetigo.

  • Mupirocin 2% ointment; apply in the affected area three times a day.
  • Cetirizine 5mls once a day for five days.
  • PO amoxyclav (400mg/57mg) 5mls BD for 1/52.

Treatment can be started empirically as you wait for the culture results. According to Nardi & Schaefer, (2021), impetigo is often a self-limiting disease. Antibiotics are used to reduce the spread of lesions and decrease the duration of illness.in addition, antibiotics lower the chances of complications involving joints, kidneys, lungs, bones and acute rheumatic fever. Case Study For Coronary Artery Assignment Paper

Follow up care

  • To comeback after one week to monitor the progress.
  • If the symptoms do not resolve and begins to spread in other areas, further investigation is advised. Repeat culture and sensitivity test to look for MRSA and provide alternative treatment.
  • Inspect house hold members for impetiginous lesions. Follow up on to ensure that the cousin is treated for the same rash.
  • Alert the school to look out for similar symptoms.

Referral

As per the moment, no referral is required. However, if symptoms persist, send for dermatological and paediatric review.

Signs of systemic illness

If the patient has systemic manifestations use of broad spectrum oral antibiotics is recommended. If patient is severely ill, they may require hospital admission to receive IV antibiotics.

Recommendation

Encourage the household to maintain proper hand washing, clothes, linen and other affected areas that have come into contact with infected fluid.

Do not share personal items such as clothing, sheets and linen until the infection is cleared.

Should patient stay out of school

According to Johnson,( 2020) Since the disease is highly contagious, it is advised that children should not go to school or day care until 24-48hours after the commencement of appropriate antibiotic therapy.

Patient Education

  • Encourage maintenance of good personal hygiene.
  • Discourage the child from touching the lesions.
  • Advise on keeping the lesions clean. Wash with warm water and soap while removing the crusts and secretions.
  • Soaps with antiseptic substances such as povidone iodine and chlorhexidine may be used.

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References

Arshad Muhammad Iqbal, & Jamal, S. F. (2022, May). Essential Hypertension. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539859/

Braun, M. M., Stevens, W. A., & Barstow, C. (2018). Stable Coronary Artery Disease: Treatment. American Family Physician, 97(6), 376–384. https://www.aafp.org/afp/2018/0315/p376.html

Gilson, R. L., & Crane, J. S. (2022, May 8). Scabies. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544306/

‌James, C., Harfouche, M., Welton, N. J., Turner, K. M., Abu-Raddad, L. J., Gottlieb, S. L., & Looker, K. J. (2020). Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 98(5), 315–329. https://doi.org/10.2471/blt.19.237149

Johnson, M. K. (2020). Impetigo. Advanced Emergency Nursing Journal, 42(4), 262–269. https://doi.org/10.1097/tme.0000000000000320

Munir S;Takov V. (2022, January 9). Generalized Anxiety Disorder. https://pubmed.ncbi.nlm.nih.gov/28722900/

‌ Nardi, N. M., & Schaefer, T. J. (2021, August 11). Impetigo. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430974/

Ojha, N., & Dhamoon, A. S. (2022, May 11). Myocardial Infarction. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537076/ Case Study For Coronary Artery Assignment Paper