Week 4 Discussion Chest Pain
CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was “a little out of shape.” He was afraid that something was wrong, so he asked his wife to call 911.
Past Medical History
Hypertension
Hyperlipidemia
Diabetes mellitus
• Gout Medications
Hydrochlorothiazide, 25 mg once daily
Allopurinol, 300 mg once daily
Social History
Retired factory worker
Smokes one pack of cigarettes per day
Drinks about six beers per day (sometimes more)
Physical Examination
Well-developed obese man in moderate distress
Height: 69 inches; weight: 252 lbs.; blood pressure: 172/110; pulse: 92; respiration rate: 16; temperature: 98.7 °F
Lungs: Scattered bilateral wheezes
Heart: Regular with grade II/VI systolic murmur
Extremities: No edema
Labs and Imaging
Complete blood count with mild leukocytosis (WBC 12.9k)
Potassium: Low at 2.9 mEq/L
Glucose: 252 mg/dL
Troponin I: 1.7 ng/L
Uric acid: 11.1 mg/dL
EKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps
CP’s admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker
Discussion Questions
1. What medications should be instituted for CP?
2. What medications should be continued after discharge?
3. What lifestyle modifications can be recommended for CP?
Medications that should be instituted for CP include:
Aspirin: to be given immediately to reduce the risk of further cardiac damage and to prevent thrombosis.
Nitroglycerin: to relieve chest pain and improve myocardial oxygen supply.
Morphine: to provide pain relief.
Heparin or unfractionated heparin (UFH) : to decrease the risk of thrombosis.
A beta-blocker: to decrease the risk of arrhythmia and to decrease heart rate and blood pressure.
A statin: to reduce the risk of further cardiac events by decreasing cholesterol levels.
ACE inhibitors or ARBs: to control hypertension and improve blood flow to the heart.
Medications that should be continued after discharge include:
Aspirin: to reduce the risk of further cardiac damage and to prevent thrombosis.
A beta-blocker: to decrease the risk of arrhythmia and to decrease heart rate and blood pressure.
A statin: to reduce the risk of further cardiac events by decreasing cholesterol levels.
ACE inhibitors or ARBs: to control hypertension and improve blood flow to the heart.
Hydrochlorothiazide: to control hypertension.
Allopurinol: to control hyperuricemia.
Lifestyle modifications that can be recommended for CP include:
Quitting smoking: to reduce the risk of further cardiac events and improve overall health.
Limiting alcohol intake: to reduce the risk of further cardiac events and improve overall health.
Maintaining a healthy diet: to control diabetes, hypertension, and obesity.
Regular physical activity: to improve cardiovascular health and overall health.
Monitoring blood glucose and blood pressure levels: to control diabetes and hypertension.
Medication adherence: to ensure optimal control of hypertension and hyperlipidemia.
Stress management techniques: such as yoga, meditation or deep breathing to reduce the risk of cardiovascular events.
It’s important to note that this patient have multiple co-morbidities and risk factors that need to be addressed, so an interdisciplinary team should be involved in the management of this patient to provide the best care.
