Question

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Courses Name:  PHC 271-Introduction to Disease

Case Study

A 55-year-old man presents to the clinic with complaints of chest pain. He states that for the past 5 months he has noted intermittent substernal chest pressure radiating to the left arm. The pain occurs primarily when exercising vigorously and is relieved with rest. He denies associated shortness of breath, nausea, vomiting, or diaphoresis. He has a medical history significant for hypertension, diabetes and hyperlipidemia. He is taking atenolol for his high blood pressure and is eating a low-cholesterol diet. His family history is notable for a father who died of myocardial infarction at age 56 years. He has a 50-pack-year smoking history and is currently trying to quit. His physical examination is within normal limits with the exception of his blood pressure, which is 145/95 mm Hg, with a heart rate of 75 bpm.
Based on the above case address the following questions.

***Please i need 500 words ..

I need new and unique answers, please. (Use your own words, don't copy and paste)

1) What is the likely diagnosis of this case? Explain, how would you classify the disease clinically?

2) Define the disease and what are the most common causes of this disease likely in the patient?

3) Are there any risk factors for the disease? If yes, then write down the common risk factors of the disease?

4) What lifestyle changes could make a difference for this patient?

5) Discuss the public health approaches in reducing and in the prevention of the health problem.

***Please i need 500 words ..

I need new and unique answers, please. (Use your own words, don't copy and paste)

Answer 1

1)

Salient features:
Middle-aged man; intermittent pain with exercise and relieved with rest; substernal location with radiation to the arm; risk factors: hyperlipidemia, hypertension, family history, cigarette smoking

How to think through:
When evaluating a patient with chest pain, first determine if the pain is acute in onset (or progressive) with features concerning for acute coronary syndrome (ACS), pulmonary embolism, aortic dissection, pneumothorax, or another emergency.

Most patients with chest pain, however, do not require emergent evaluation. This patient's chest pain has characteristics of typical angina, including substernal location, exertional onset, radiation to the arm, and relief with rest.

Risk factors for coronary artery disease (CAD) are weighed along with history, examination, and electrocardiogram (ECG). What are the major CAD risk factors? (Age, sex, family history, tobacco use, diabetes mellitus, hypertension, low high-density lipoprotein [HDL] cholesterol, high non-HDL cholesterol.)

Could this be aortic stenosis? (Based on history alone, it could be. Cardiac and carotid pulse examination will be helpful.) Although other causes (esophageal spasm or musculoskeletal pain) are possible, the symptoms, long smoking history, and family history confer a high pretest probability of CAD.

There are several noninvasive CAD testing options; all involve a stressor (exercise or pharmacologic) and a detector (ECG, echocardiography, nuclear medicine). Is medical therapy indicated at this point? (Yes. Aspirin, statin, β-blocker, and nitroglycerin therapy, given the high suspicion for CAD.)

Essentials of Diagnosis
-Inquire about
• Chest pain onset, character, location, duration, frequency, and exacerbating and alleviating factors
• Presence of shortness of breath
-Vital signs; chest and cardiac examination
-ECG
-Cardiac biomarkers

medicines- Atorvastatin 80 mg, Clopidogrel 300 mcg, GTN 500 mcg, Ramipril 2.5 mg,

2) disease detais:

Acute Coronary Syndrome

•Chest pain usually more severe and lasts longer than typical angina

•Plaque rupture with acute thrombus development

•Unstable angina—occlusion is partial

•MI—occlusion is complete

3)

Risk factors

There are certain risk factors associated with acute coronary syndrome that people should be aware of. Risk factors include:

• Older age – men of 45 years or older, women aged 55 years or older
• High blood pressure or cholesterol
• Smoking
• Lack of physical activity
• Unhealthy diet, obesity, or overweight
• Diabetes
• Family history

4)

Lifestyle changes

In some people, acute coronary syndrome may be prevented. Heart disease can lead directly to acute coronary syndrome, but those who do not have heart disease can protect themselves by practicing a healthy lifestyle:

• Following a heart-healthy diet: Eating a diet that includes fruits, vegetables, whole grains, and lean protein.
• Not smoking: Those who smoke can try medicines and counseling to help them quit.
• Being active: Engaging in regular exercise to stay physically fit. People should aim for moderate exercise at least 2-3 hours a week.
• Paying attention to the numbers: People should know their blood pressure and cholesterol levels and understand what the numbers mean as well as the optimum range.
• Maintaining a healthy weight.
• Drinking alcohol in moderation: Drinking more than one or two alcoholic drinks per day can raise blood pressure.

People who have had problems such as a heart attack in the past may also be instructed to take one baby aspirin in addition to their daily medication. Aspirin helps to prevent platelets from forming clots and helps to reduce the risk of a second heart attack by around 22 percent.

With lifestyle changes and the right medication, it is possible to prevent acute coronary syndrome or to treat it and lead a normal life.

5)

Medications
Treatment must be guided by underlying etiology.
• Short-acting as-needed nitroglycerin, daily aspirin, β-blocker, long-acting nitrate, statin for stable angina pectoris.
• Empiric trial of high-dose proton pump inhibitor therapy has been reported to improve symptoms in patients with noncardiac chest pain of unknown etiology.
• Antidepressants may have modest benefit in reducing noncardiac chest pain.
• Psychological interventions (especially cognitive-behavioral) may have modest to moderate benefit.
• Hypnotherapy may have some benefit.