Unstable Angina Results Of A Myocardial Ischemia

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

Can be caused by indigestion, emotional stress, when one's heart is working very hard, and not getting as much oxygen as the heart needs. After rest, the pain goes away. Stable Angina does not last very long.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

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.

We present a case of 51-year-old male who presented to emergency room with complaints of typical chest pain.

Variant angina can occur in people who do not even have hart disease. It is rare, but is the result of coronary artery spasms. The spasms cause the walls to constrict which lessens or stops the blood flow to the heart.

“Ischaemic Heart Disease is a condition of recurring chest pain or discomfort that occurs” [II]. This happens due to the heart not gaining the required amount of oxygen. This condition takes place when there’s physical exertion or excitement, due to the heart requiring greater blood flow and not receiving it, or in this case very little amount of it.

Angina is associated with clinical events that can affect prognosis, for example Von Arnim et al

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

Stable angina – this occurs when the heart has to work harder than it normally needs too. Example when excising, you might overexert yourself and feel chest pain or discomfort. Sometimes overeating or eating too fast may cause this condition as well. Smoking is also a factor. Extremes in emotion such as being too angry or upset may also provoke this condition.

Arteriolar vascular constriction, heart rate increases, and renal retention of sodium and water all help to regulate cardial output. Ventricular dilatation is commonly seen. A large amount of ventricular myocardium is lost, contractility may be greatly compromised, and cardiogenic shock may ensue.

A person can be affected by ischemia for a short period of time or a long period of time. It can be happening as the person is resting or if they have a weak heart. A person who is over exerted physically, coronary artery disease, blood clots, or coronary artery spasm can be candidates for having ischemia. Symptoms of myocardial ischemia are: chest pain/pressure with is normally on the left side which is also known as angina pectoris, neck/jaw pain, shoulder/arm pain, a