CAD And Pacemakers Case Study

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CaseStudyCoronaryArteryDiseaseandPacemakers

 

 

 

 

It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P. is a 60-year- oldretiredbusinessmanwhoismarriedandhasthreegrownchildren.Asyoutakehishealthhistory,he tellsyouthathebeganfeelingchangesinhischestabout10daysago.Hehashypertension(HTN)and a 5-year history of angina pectoris. During the past week, he has had frequent episodes of mid-chest discomfort.Thechestpainrespondstonitroglycerin(NTG),whichhehastakensublinguallyabout8to 10timesoverthepastweek.Duringtheweek,hehasalsoexperiencedincreasedfatigue.Hestates,“I justfeelcrappyallthetime.”Acardiaccatheterizationdoneseveralyearsagorevealed50%stenosisof the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. Hetellsyouthatbothhismotherandhisfatherhadcoronaryarterydisease(CAD).Heiscurrentlytaking amlodipine(Norvasc),metoprolol(Lopressor),atorvastatin(Lipitor),andaspirin81mg/day.

 

  1. Whatotherinformationareyougoingtoobtainabouthisepisodesofchestpain?

 

 

 

 

 

 

 

  1. Whatarecommonsitesforradiationofischemiccardiacpain?

 

 

 

 

 

 

 

 

  1. You know that G.P. has atherosclerosis of the coronary arteries. You need to know his risk factors for CAD to plan teaching for lifestyle modifications. What will you ask him about?

 

 

  1. Although he has been taking sublingual nitroglycerin (SL NTG) for a long time, you want to WhichactionsarecorrectwhentakingSLNTGforchest pain?(Selectallthatapply.)
  2. Stoptheactivityandlieorsit
  3. Call911
  4. Call911ifthepainisnotrelievedaftertakingoneSL
  5. Call911ifthepainisnotrelievedaftertakingthreeSLtablets,5minutes
  6. Chewthetabletslowlythen
  7. PlacetheNTGtabletunderthe

 

 

 

  1. P.WhichstatementbyG.P.indicatesa needforfurthereducation?Explainyouranswer.
  2. “Iwilldiscardanyopenbottleofnitroglycerinaftera”
  3. “Iwillnotstoreotherpillsinthenitroglycerin”
  4. “Icarrythetabletswithmeatall”
  5. “Iwillkeepthepillsintheiroriginalbrown”

 

 

 

CASESTUDYPROGRESS

WhenyoufirstadmitG.P.,youplacehimontelemetryandobservehiscardiac rhythm.

 

  1. Identifytherhythm:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. P.’shistory.Whatconditionsmayhavecontributedtothedevelopmentofthis dysrhythmia?

 

 

 

 

 

 

 

 

  1. P.’slaboratorytestresultsandnotethatallofthemarewithinnormalrange, including troponin and creatinine phosphokinase (CPK) levels. His potassium level is4.7mEq/L. Given this and his current dysrhythmia, what is the likely cause of the symptoms hehasbeenexperiencingthispastweek?

 

 

 

 

 

 

 

 

CASESTUDYPROGRESS

Withinthehour,G.P.convertswithintravenousdiltiazem(Cardizem)tosicksinussyndromewithlong sinus pauses that cause lightheadedness and hypotension.

 

  1. P.?Explainthereasonsforyour answers.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASESTUDYPROGRESS

BecauseG.P.’sdysrhythmiaiscausingunacceptablesymptoms,heistakentosurgeryandapermanent DDDRpacemakerisplacedandsetatarateof70beats/min.

  1. WhatdoesthecodeDDDRmean?

 

 

 

 

 

 

  1. P.atriskforseveralseriouscomplications.List threepotentialproblemsthatyouwillmonitorforasyoucareforhim.

 

 

 

 

 

  1. P.willneedsomeeducationregardinghisnewpacemaker.Whatinformationwillyougive himbeforeheleavesthehospital?

 

 

 

 

  1. P.’s wife approaches you and anxiously inquires, “My neighbor saw this science fiction movieaboutthisguywhogotapacemakerandthenhecouldn’tdie.Isthatforreal?”How areyougoingtorespondtoher?

 

 

 

 

 

 

 

  1. P.andhiswifetellyoutheyhaveheardthatpeoplewithpacemakerscanhavetheirhearts stop because of microwave ovens and cell phones. Where can you help them find more information?

 

CASESTUDYPROGRESS

Afterdischarge,G.P.isreferredtoacardiacrehabilitationcentertostartanexerciseprogram.Hewill beexercisetested,andanindividualizedexerciseprescriptionwillbedevelopedforhim,basedonthe results of the exercise test.

 

  1. What information will be obtained from a graded exercise (stress) test, and what is included inanexerciseprescription?