Patient Profile: 68-Year-Old White Man Presents To The Clini

Patient Profilefm Is A 68 Year Old White Man Who Comes To The Emerge

Patient Profile F.M. is a 68-year-old white man who presents to the emergency department (ED) with a two-day history of severe chest pain that began upon waking and worsened overnight. The pain was previously relieved by rest but has become more severe and persistent, no longer alleviated by rest. He also reports slight nausea. His medical history includes recurrent chest pain over the past six months that was relieved by rest, suggesting stable angina which has now progressed to unstable angina or acute coronary syndrome. His familial history is notable for a father who died of a heart attack at age 62. The patient smokes one pack of cigarettes daily and leads a sedentary lifestyle. On physical examination, he exhibits elevated blood pressure (180/96 mm Hg), tachycardia (98 bpm), and is diaphoretic and clammy. Cardiac examination shows a regular rhythm without murmurs, and lung sounds are clear. Laboratory and diagnostic tests reveal normal hemoglobin, a normal chemistry panel, pending cardiac markers, and an electrocardiogram indicative of non–ST-segment–elevation myocardial infarction (NSTEMI). Treatment includes IV fluids, nitroglycerin, and morphine for pain relief.

Paper For Above instruction

Understanding the intricacies of coronary artery disease (CAD), including risk factors, clinical presentation, diagnostics, and management, is essential for providing comprehensive care. This case study of F.M., a 68-year-old man presenting with evolving chest pain, exemplifies the typical clinical progression from stable angina to a potential myocardial infarction (MI). Addressing his modifiable and nonmodifiable risk factors, differentiating between chronic stable angina and acute MI pain, and outlining appropriate diagnostic and therapeutic interventions are critical components of patient-centered care.

Risk Factors for Coronary Artery Disease

F.M.'s risk factors for CAD can be classified into modifiable and nonmodifiable categories. Modifiable risk factors are behaviors or conditions that can be altered to reduce risk. In his case, smoking and a sedentary lifestyle are prominent modifiable risk factors. Smoking contributes to endothelial damage, promotes atherosclerosis, and increases the risk of thrombotic events (Benowitz, 2010). A sedentary lifestyle fosters obesity, hypertension, insulin resistance, and dyslipidemia, all well-established contributors to atherosclerosis (Fletcher et al., 2018). Although his BMI is just under 30, indicating overweight status, weight management through lifestyle modifications could mitigate some risk factors.

Nonmodifiable risk factors include age, gender, and family history. F.M.’s age (68 years) and gender (male) elevate his risk for CAD (Lloyd-Jones et al., 2010). His familial history of early-onset heart disease, with his father dying at 62 from a heart attack, further amplifies his genetic predisposition. These factors highlight the importance of early screening and aggressive management of modifiable risks in individuals with significant nonmodifiable risk factors (Goff et al., 2014).

Differences Between Stable Angina and MI Pain

Chronic stable angina is characterized by predictable episodes of chest discomfort that are precipitated by exertion or emotional stress and relieved by rest or nitroglycerin. The pain is typically described as a heaviness or pressure and lacks associated symptoms such as nausea or diaphoresis. In contrast, pain associated with MI, particularly in progression to unstable angina or NSTEMI, is often more severe, prolonged (lasting more than 20 minutes), and occurs at rest. Patients may also experience associated symptoms like nausea, diaphoresis, dyspnea, or dizziness (Thygesen et al., 2018). The transition from stable angina to unstable angina or MI involves plaque rupture and thrombosis, leading to a more intense and unrelenting pain pattern, as seen in F.M.'s case.

Diagnostic Studies for F.M.

The initial diagnostic approach in suspected acute coronary syndrome (ACS) includes electrocardiography (ECG) and cardiac biomarkers. In F.M.’s case, his ECG shows changes consistent with NSTEMI, indicating myocardial ischemia without ST-segment elevation. Cardiac enzymes such as troponins are essential for confirming myocardial injury and are being processed. A complete blood count, comprehensive metabolic panel, lipid profile, and coagulation studies help assess overall cardiovascular risk and organ function. Further imaging, such as echocardiography, can evaluate cardiac function and identify wall motion abnormalities. Coronary angiography may be indicated for definitive assessment and potential revascularization if clinical status warrants (Amsterdam et al., 2014).

Priority Nursing Care for F.M.

The primary nursing priorities in acute MI include assessing and monitoring cardiac status, managing pain, ensuring adequate oxygenation, and preventing complications. Continuous cardiac monitoring detects arrhythmias, while vital signs help assess hemodynamic stability. Administering prescribed medications such as nitroglycerin to alleviate ischemia and morphine for pain relief is crucial, as seen in F.M.’s treatment. Ensuring IV access and fluid balance is also essential, especially given his hypotensive potential and risk of arrhythmias. Patient education about activity restrictions, medication adherence, and recognizing signs of worsening condition is fundamental in his recovery (American Heart Association, 2020).

Additional Interventions for F.M.

Beyond initial stabilization, further interventions may include initiating antiplatelet therapy (e.g., aspirin and possibly P2Y12 inhibitors), beta-blockers to reduce myocardial oxygen demand, statins for lipid management, and anticoagulation therapy if indicated. Early transfer to a cardiac catheterization facility for diagnostic angiography and possible percutaneous coronary intervention (PCI) is often warranted to restore coronary blood flow (O'Gara et al., 2013). Lifestyle modifications, including smoking cessation, diet, and supervised exercise programs, are vital components of secondary prevention. A multidisciplinary approach involving cardiologists, nurses, dietitians, and behavioral health specialists ensures a holistic plan targeting risk factors and promoting cardiac health (Ibanez et al., 2018).

Common Complications After an MI

Post-MI complications can be life-threatening and include arrhythmias (such as ventricular fibrillation), heart failure due to left ventricular dysfunction, cardiogenic shock, pericarditis, and ventricular aneurysm formation. Thromboembolic events and recurrent ischemia are also concerns. Early recognition and intervention—such as antiarrhythmic therapy, mechanical support, or surgical intervention—are vital to improving outcomes (Kumar & Cannon, 2015). Additionally, long-term complications involve remodeling of the myocardium, leading to chronic heart failure, emphasizing the importance of secondary prevention strategies.

Conclusion

The case of F.M. underscores the importance of identifying risk factors, understanding clinical differentiation between stable angina and MI, and implementing prompt, evidence-based interventions. Effective management requires a multidisciplinary approach, educating patients on risk modification, and vigilant monitoring for complications. Prevention and early treatment are paramount to reducing morbidity and mortality associated with coronary artery disease.

References

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