The patient is a 57-year old woman with a history of hypertension and chronic stable angina.

The patient is a 57-year old woman with a history of hypertension and chronic stable angina. She arrives in the ED complaining of indigestion-type pain that occurs more frequently than her chest pain and takes over 20 minutes to go away. She appears mildly short of breath, with vital signs of BP 155/98, pulse rate 100, respiratory rate 24/min.

What should be considered as the most likely cause of this patient’s pain? Why?
What is the difference between stable and unstable angina?
Why might this new pain most likely be considered unstable angina?

Solutions

Expert Solution

a) The patient presents with complaint of indigestion type pain frequently occurring on her chest and takes 20 minutes to go away. Heartburn or indigestion type pain is occurring due to the acid reflux and GERD which causes pain in the chest. Sometimes the patient feels the similar pain in the chest during an attack of angina or heat attack. By verifying the values of vital signs including the blood pressure variations and respiratory rate and assessing the breathing variation will helps to identify the cause for pain.

In angina, the patient will feel the similar type of pain as the pain in the indigestion. The pain occurs when the heart muscles doesn’t get enough oxygen rich blood. The pain will feel like pressure or squeezing the chest.

b) Differences between stable and unstable angina

Stable angina	Unstable angina
Stable angina occurs during a physical exertion or emotional stress	Pain occurs at rest or with exertion or with stress
Pain will lasts for 2-5 minutes	Pain will lasts for more than 10 minutes
Ischemia occurs due to the narrowing of the arteries will prevent the heart to receive more oxygen.	Ischemia occurs due to the dynamic obstruction of the arteries which leads to the rupturing and plaques and formation of thrombosis
Seizures occurring are predictable	Seizures occurring are not able to predict
Can be diagnosed by ECG	Can be diagnosed by coronary angiography
No changes in ECG	Changes in ST segment and T waves
Pain can be relieved by the intake of Nitroglycerin	Emergency treatment is required to avoid further risk for myocardial infarction and cardiac arrest.

c) The pain can be considered as unstable angina why because usually the pain in the stable angina will last for only 5 minutes and will relive soon by a nitroglycerin and by taking rest. But in this case the patient is feeling the pain more frequently than her chest pain and it takes 20 minutes to relive from the pain. Along with this the vital sign of the patient is pointing to the unstable angina. Here the patient is feeling tachypnea( Respiratory rate is more than 20beats /min) and have high blood pressure of 155/98 is leading to the risk for myocardial dysfunction and the pulse rate of 100 beats / min is showing tachycardia in the patient. These all vital signs variations are leading to the occurrence of unstable angina in this patient.

Nightingale answered 1 year ago

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