Question

Case Study: Acute Coronary Syndrome (ACS) Coronary Artery Disease (CAD) Mr. Nguyen is a 46-year-old man admitted to the emergency department with chest discomfort. His history reveals a history of smoking a pack of cigarettes per day. He relies on a fast food diet since his kids moved out of the house and he is divorced and lives alone. His father died at the age of 60 due to heart problems. He reveals that his chest pain started while he was shoveling snow from his walkway. He had experienced chest discomfort with activity previously, but the pain had subsided with rest and he sought no medical help. This time the pain did not subside and became increasingly severe, radiating to his left arm and lower jaw. In the emergency department, an ECG and cardiac enzymes were obtained. The cardiac monitor showed sinus tachycardia with occasional premature ventricular complexes. Mr. Nguyen was treated with nasal oxygen chrombolytic therapy, sublingual nitroglycerim and IV (norphine sulfate. When he was paintrée, he was transferred to the cardiac unit for monitoring ac monitor Was pain free, hemolytic therapyshunicular complexes Discussion Questions 1. Describe the difference between arteriosclerosis and atherosclerosis? Which do you think contributed to Mr. Nguyen's chest discomfort? Explain 2. Identify risk factors that aid in the development of atherosclerosis in this case? List other potential risk factors in the development of atherosclerosis? 3. Describe the difference between acute coronary syndrome and myocardial infarction 4. What clinical manifestations occur with acute coronary syndrome? 5. What different manifestations occur with myocardial infarction? 6. What would be the potential difference in clinical manifestations for women and older adults? 7. List the tests that confirm a diagnosis of myocardial infarction. Mr. Nguyen is discharged and 6 months later he visits his nurse practitioner because he has been noticing an inability to complete yard work because of shortness of breath and Increased fatigue. He's diagnosed with congestive heart failure (CHF). 8. What is the pathophysiology of CHF? What is the relationship between his past MI and CHF? 9. Compare and contrast right sided CHF and left sided CHF.

Answer 1

1. Difference between arteriosclerosis and atherosclerosis.

Arteriosclerosis is the hardening and stiffening of arteries which leads to loss of elasticity of the arterial walls which restrict the of blood flow through them.

Atherosclerosis is a type of arteriosclerosis in which the fat molecule accumulate Barton the walls of the arteries and form plaques which cause narrowing and hardening of the arterial walls and leads to restriction of blood flow through it.

The patient in this case may have developed chest pain due to the condition known as atherosclerosis because the patient has history of smoking and a diet which is not healthy. Both of this can contribute to damage of endothelial lining of cardiac blood vessels and formation of cholesterol plaques in the coronary arteries which reduce the blood flow to coronary muscles and leads to chest pain.

2. The risk factors to develop atherosclerosis in this case is smoking, diet habit and the family history of cardiac disease and death. Smoking damage the blood vessels and the fast food diet can leads to increased cholesterol level in the blood which may leads to plaque formation and clogging of arteries. Genetics also play an important role in atherosclerotic diseases where people who have a parent or sibling with atherosclerosis have at higher risk of atherosclerosis than others.

Other risk factors include

• Obesity
• Diabetes
• Hypertension
• Lack of exercise

3. Acute coronary syndrome is a group of clinical manifestations due to plaque, rupture or clot formation in the coronary arteries which leads to sudden reduction or obstruction of blood flow to the Cardica muscles.

Myocardial infarction is classified under acute coronary syndrome in which the block of blood flow through the coronary arteries leads to damage of cardiac muscles.

4. Clinical manifestations in acute coronary syndrome

• Intermittent chest discomfort or heaviness like feeling of pressure, tightness or fullness.
• Feeling of discomfort in one or both shoulders or inside of one or both arms, through the back, and in the throat, jaw, or teeth.
• Shortness of breath
• Dizziness and fatigue
• Diaphoresis
• Nausea

5.Clinical manifestations of Myocardial infarction

The MI has almost similar clinical manifestations, even though the chest pain and discomfort will be more frequent and felt on the middle of the chest that may spread to the back, jaw, or left arm more often than to the right arm compared to the acute coronary syndrome. The pain will be continuous may be for 20 minutes with sensation of pressure, tightness, knifelike, tearing, burning sensation and not relieved by rest or Nitroglycerine. Anxiety is seen in these patients along with palpitations, heartburn, indigestion, nausea, or vomiting.

6. Comparing to men, women are more likely to experience severe chest pain episodes, shortness of breath, nausea or vomiting and back or jaw pain. Older patients can also experience fainting or syncope with or without typical symptoms.

7. Diagnostic test to confirm Myocardial infarction

• Electrocardiogram
• Cardiac biomarkers like creatine kinase and cardiac troponins T and I
• Stress echocardiography is an ultrasound scan of the heart.
• Myocardial perfusion imaging and angiography