Discussion Questions: John Miller, a 65-year-old patient, was referred to the cardiologist's office for an evaluation. The patient had recently started an exercise program for weight loss. For the last 3 weeks, following exercise, he had noticed radiating chest pain (angina pectoris) that stopped after rest. This condition had worsened in the last week. The cardiologist ordered a stress echocardiogram (a test that visualizes the heart during increasing stress). The stress echocardiogram results suggested that the patient had coronary artery disease (CAD). The patient was scheduled for a cardiac catheterization the next morning. It was noted in the patient's chart that he smoked two packs of cigarettes per day 1.What symptoms suggest that this patient is suffering from coronary artery disease and not some other disorder? 2.Why is it important to test the heart under stress rather than obtaining a resting echocardiogram? 3.Why is a cardiac catheterization needed in addition to the stress echocardiogram? 4.What lifestyle changes should this patient make to prevent future heart attacks?
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The symptoms that suggest that this patient is suffering from coronary artery disease include radiating chest pain (angina pectoris) that occurs after exercise and stops after rest. This condition has worsened in the last week. Additionally, the patient has a Show more…
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Madhur L.
A 45-year-old engineer presents to the ER complaining of severe, intense, precordial crushing sensation with pain radiation 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 are the following: heart rate of 98 beats/min, blood pressure of 160/110 mmHg, and the respiratory rate of 24 breaths/min. An EKG is performed and reveals ventricular extrasystole arrhythmia (premature ventricular contraction [PVC]) as well as ST segment depression and decreased R-wave height. An exercise tolerance test is performed which demonstrates a downward sloping ST segment. Coronary angiography shows luminal obstruction >75% (91%) in three major coronary vessels, including the left anterior interventricular (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 used to describe chest pain experienced by this patient? Describe the mechanism for chest pain. Describe the different types of chest pain. Explain the mechanism of action and the rationale for administering nitroglycerin, beta-blockers, and calcium channel blockers.
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