Cardiovascular Case Essay

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Case 2 - A 45 year old engineer presents to the ER complaining of a severe, intense, precordial, crushing sensation with pain radiating to the left shoulder and down the side of the left arm, triggered by exercise. the chest discomfort brought on by the exertion is relieved by rest. ER examination results in the following: 98 beats/min heart rate, BP of 160/110mmHg, and a respiratory rate of 24 breaths/min. EKG is performed and reveals ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as ST segment depression and decreased R-wave height. Coronary angiography shows luminal obstruction >75% (91%) in three major coronary vessels, including the left anterior in ventricular (descending) coronary artery. The patient is started on nitroglycerin, beta blockers, and calcium channel blockers. Angioplasty is scheduled for the next morning. • What is the term for the chest pain experienced by this individual? This pain is called angina pectoris. • What is the diagnosis? I would diagnose a stable angina for this patient. • Explain the mechanism of actions and the rationale for administering nitroglycerin, beta- blockers, and calcium channel blockers. Nitroglycerin is a smooth muscle relaxer and vasodilator. This drug provides myocardial oxygen which reduces myocardial wall tension. Reduction in myocardial wall tension corresponds with lower systolic pressure. Beta blockers are antagonistic beta receptor blockers which act on the heart to reduce the amount of work the cardiac muscles have to do. By blocking beta receptors, the heart rate will be slowed and reduces demand for oxygen and contractility. By slowing the heart rate, diastole will increase and the time of coronary blood flow will increase. With a decreased heart rate and contractility, the amount of work the heart has will also decrease. Calcium channel blockers are used to treat
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