Stable Angina Case Study

Thomas’ chief complaint was a persistent, crushing chest pain that radiates to his left arm, jaw, neck, and shoulder blade. He also described the pain as a squeezing sensation around his heart. The medical term for this patient’s chief complaint is angina pectoris. Angina pectoris is the medical term for the chest pain or discomfort due to coronary heart disease.

First, Coronary Artery Disease is a serious heart condition that impairs blood flow to the heart muscle. A nurse should have knowledge of the disease process, signs and symptoms, diagnostic tests, and treatments available. The coronary arteries supply blood, oxygen, and nutrients to the heart. The main coronary arteries are the left and the right arteries. The left coronary artery. The disease is typically caused by plaque accumulation in the coronary arteries. Atherosclerosis is the formation of plaque affecting layers of the large and midsize arteries. Plaque contains cholesterol, triglycerides, phospholipids, and collagen. When plaque accumulates in the arteries it decreases the size of the inside of the arteries. Plaque may surround the

Coronary Artery Disease (CAD) is a type of heart disease where plaque accumulates in the coronary arteries, which provide blood to the heart. The plaque is made of cholesterol deposits, and when it builds up in the arteries, it causes the arteries to slowly narrow (atherosclerosis). A very common symptom of CAD is angina, which is caused by the buildup of plaque. Angina is chest pain that is caused by reduced flow of oxygen rich blood to the heart. This makes the heart muscle weak, and can lead to another symptom of CAD, arrhythmia. Arrhythmia is an irregular heartbeat. However, sometimes these symptoms don’t show up at all. The first indication of CAD in some people is a heart attack. A heart attack is when a plaque buildup blocks an artery completely and thus, stops blood flow to the heart.

Angina pectoris is a condition that is seen very often in the healthcare setting. According to Hemingway, McCallum, Shipley, Manderbacka, and Martikainen, Keskimäki (2006) commonly, the age of those affected by this condition

The coronary arteries supply oxygenated blood to the heart muscle. Plaque is a substance that can clog these arteries and cause a condition called atherosclerosis. The buildup of plaque can occur over many years which can ultimately lead to coronary heart disease (CHD). Plaque can harden and cause the arteries to become narrowed. This reduces the flow of oxygenated blood. Plaque may also burst and a blood clot may form causing a blockage of blood flow to the heart. In result to the blockage angina or a myocardium infarction can occur.

Coronary artery disease (CAD) is the commonest heart disease in the United States1. Approximately, 29% of patients with Myocardial Infarction ( MI ) present with ST- elevation Myocardial Infarction ( STEMI )2. STEMI is the result of complete occlusion of a major epicardial coronary artery due to thrombus formation. STEMI from a small coronary artery presenting as substantial EKG abnormalities similar to occlusion of a major artery and hemodynamic instability is a rare entity. The epidemiology, typical clinical presentation, outcomes, and optimal management in this group of patients are not sufficiently known.

The most common type of heart disease is called coronary artery disease. Coronary artery disease develops when the arteries narrow and become hard. The heart cannot receive all the blood it needs through the stiff narrow arteries. Symptoms include pressure and chest pain or squeezing in the chest which is also known as angina. Angina should be understood as a warning sign and that the sufferer is at an increased risk of a heart attack. When blood is blocked from getting to the heart for more than twenty minutes the result is a heart attack. The symptoms of a heart attack can be less dramatic than what television portrays. The Clutching of the chest and falling to the floor is not what women should expect. The common signs for women to look for are heartburn, loss of appetite, feeling tired or weak, shortness of breath, nausea, and pain in the back, neck or jaw. Women should not hesitate to call for help should they experience these symptoms. It is important that women do not let shame or embarrassment keep them from taking action to insure their safety.

Ivabradine has captured the attention of scientists and has opened up new possibilities for the treatment of stable angina and chronic heart failure. Ivabradine is being developed as an anti-angina drug in patients with stable coronary artery disease and was found to reduce heart rate by selectively inhibiting the pacemaker (If) current in the sinoatrial node (Jedlickova et al., 2015). Recent studies have noted how the reduction of heart rate caused by ivabradine has broader implications on heart health, and also how ivabradine can potentially improve cardiovascular disease (CVD) by mechanisms other than heart rate reduction. Studies have also looked at using ivabradine in more than just treating stable chronic angina, but also in other types of CVD and even chest pains. O 'Connor et al., (2016) examined the effects of ivabradine following myocardial infarction in mice and Jedlickova et al., (2015) through studying ivabradine used as an angina treatment in humans, looked at the effects of ivabradine on endothelial function. These studies have highlighted how ivabradine may not only be beneficial as a treatment via heart rate reduction, but also through pleiotropic mechanisms (Heusch and Kleinbongard, 2016). Ivabradine is an important area of research because it can be useful in more than one context.

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

In Focus on Pharmacology Essentials For Health Professionals, Jahangir Moini states “angina pectoris is a common form of ischemic heart disease and often precedes and accompanies MI” (Moini, 2013. p.359). When having angina, a patient will feel pressure in the chest like a squeezing sensation and the pain can travel to the jaw, down the arm, into the neck, shoulders, or back.

Pathophysiology: This is a disorder characterized by pressure or squeezing pain in the chest due to insufficient oxygen supply in the heart muscle. It occurs after a buildup of plaque in the arteries supplying blood to the

Mr. Simons had history of myocardial infarction and atrial fibrillation. Moreover, he complains of chest pain radiating down his left arm during night, and his pain score is 6 out of 10. The vital signs at 6:30 show blood pressure is 130/80 and pulse is irregular. Ask patient to describe more about the chest pain—the duration, frequency characteristics and way to relief pain used before. () The causes of the chest pain are varied because of the complex system of the body (Skinner, 2010). It is crucial to clarify the symptoms of the chest pain to relate with disease. Plus, ask the patent if he has other cardiovascular diseases and peripheral disease or family members who have. () The reason causes the cardiac disease including heredity. Therefore, understanding the past clinical history and family history of the patient can give clues to

The patient major symptom of chest pain, accompanied by SOB and diaphoresis prompted him to seek help in the emergency room (ER). He had this similar symptoms that eased up with rest for the past six months. However, in the past four days the symptoms became severe and unbearable. The patient returns to the hospital for follow up visit regarding the stent placement and review of risk factors associated with angina. The patient is still apprehensive of experiencing another episode of angina.

Current Treatment and Consideration of Evidence Base: Upon admission, patient was most-likely suspected of having ACS (acute coronary syndrome) because of CHD (coronary heart disease) (NICE, 2014c). Troponin T High Sensitivity Test was carried out to distinguish whether chest pains were because of NSTEMI or unstable angina (NICE, 2014b). This led to diagnosis of unstable angina. His current treatment with regards to drug interactions is okay, except that enoxaparin has a clinically significant interaction with aspirin (2015, p. 1199). This can be discounted for due to his condition.

     People with coronary heart disease, whether or not they have had a heart attack, experience