Patient complains of having tightness and pain in his chest that seems to move down the left arm. Patient describes the pain as being sharp and can be sometimes a mild pain or an immobilizing pain.
Coronary Artery Disease
Pathophysiology of: Angina Pectoris
Angina Pectoris develops when coronary blood flow becomes inadequate to meet myocardial oxygen demand. This causes myocardial cells to switch from aerobic to anaerobic metabolism, with a progressive impairment of metabolic, mechanical, and electrical functions. Angina pectoris is the most common clinical manifestation of myocardial ischemia. It is caused by chemical and mechanical stimulation of sensory afferent nerve endings in the coronary vessels and myocardium. These nerve fibers extend from the first to fourth thoracic spinal nerves, ascending via the spinal cord to the thalamus, and from there to the cerebral cortex. (http://emedicine.medscape.com/article/150215-overview, 6/15/10 12:30 pm)
Coronary intravascular ultrasonography
A coronary intravascular ultasonography is an invasive ultrasound performed from a transducer within the lumen of the coronary arteries. (Laboratory test and diagnostic procedures, By: Cynthia Chernicky, 5th Edition 2008).
Electrocardiography is a noninvasive acoustic imaging procedure that determines the size, shape, position, thickness and movements of the heart valves, walls, and chambers during each cardiac cycle. (Laboratory test and diagnostic procedures, By: Cynthia Chernicky, 5th Edition 2008).
Lipid Profile; Blood
Lipid profile; blood is a test to check the units of each of the following:
Total HDL Cholesterol ratio.
Stress Exercise Test
Stress exercise test measures the efficiency of the heart during a period of physical stress on a treadmill or on a stationary bicycle.
Classification: Vasodilator, antihypertensive.
Action: Reduces preload and afterload, decreasing myocardial workload and oxygen demand.
Uses: To prevent or treat angina pectoris, hypertension, and heart failure.
Contraindications: Acute Myocardial Infarction, angle- closure glaucoma, cerebral hemorrhage, concurrent use of phosphodiesterase inhibitors, constrictive pericarditis.
Route and Dosage: Adults: PO 1 mg. tablet every 5 hours while awake. (Buccal) 0.1
To 0.8 mg. /hr. worn 12 to 14 hours at a time. (Transdermal Patch)
Adverse Reactions: Some side effects of this drug that should be reported to a healthcare provider if they become severe are as follows: •
Side effects with potentially serious effects are called adverse effects and need to be reported to a healthcare provider immediately. The adverse effects of nitroglycerin are:
• blurred vision
• fainting spell
• abdominal pain
• chest pain
• pale skin
• peeling of the skin
• blisters on the skin
• difficulty breathing
Transluminal coronary angioplasty
Your heart’s arteries can become clogged from a buildup of cholesterol, cells or other substances. This can reduce blood flow to your heart and cause chest discomfort. Sometimes a blood clot can suddenly form or get worse and completely block blood flow, leading to a heart attack. Angioplasty opens blocked arteries and restores normal blood flow to your heart muscle. Angioplasty, a type of percutaneous coronary intervention (PCI), is not major surgery. It is done through a small puncture in a leg or arm artery and opens a clogged heart artery by inflating a tiny balloon in it....
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