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?

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 2 years ago

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...

Martha Moore is an 87-year-old woman with a history of osteoporosis and hypertension. She had an...

Martha Moore is an 87-year-old woman with a history of osteoporosis and hypertension. She had an exploratory laparotomy for a small-bowel obstruction 2 days ago. Before assessing this patient you notice her hemoglobin level is 9 mg and her SaO2 is 90%. You do her morning assessment and she reports her cough kept her awake last night. Currently her temperature is 101⁰ F, her BP is 150/78, her heart rate is 100, and her respiratory rate is 24 breaths/min. On...

5. A patient with chronic-stable angina begins taking metoprolol, and once blood levels reach the therapeutic...

5. A patient with chronic-stable angina begins taking metoprolol, and once blood levels reach the therapeutic range the frequency and severity of angina attacks and the need for sublingual nitroglycerin were reduced. Which of the following states the direct pharmacologic action by which the beta-blocker produced the desired effects? A. Decreased myocardial oxygen demand B. Dilated coronary vasculature C. Directly inhibited angiotensin II synthesis D. Reduced total peripheral resistance 6. A patient with newly diagnosed essential hypertension starts treatment with...

57 Year Old Woman with Fatigue Chief Complaint: Fatigue History of Present Illness: Ms. Jones is...

57 Year Old Woman with Fatigue Chief Complaint: Fatigue History of Present Illness: Ms. Jones is a 57 year old woman who presents to her primary care physician with a three month history of fatigue. She reports that she doesn’t seem to have as much energy as she used to for daily activities. She has also noted increased frequency of urination, often having to get up two to three times a night to go to the bathroom. She has increased...

A 68-year-old patient with a history of hypertension and obesity had a myocardial infarction (MI) 3...

A 68-year-old patient with a history of hypertension and obesity had a myocardial infarction (MI) 3 months ago. His physician has placed him on a 2000-calorie low-salt diet, but the patient is struggling to be compliant with the dietary changes. He continues to manage his Italian restaurant; he loves to cook, sample the menu, and entertain his guests with huge portions. At his 3-month check, he has lost 2 lb. His blood pressure remains 148/90 mm Hg, and he has...

A 21 year old male presents to the ED with stable angina. He underwent a full...

A 21 year old male presents to the ED with stable angina. He underwent a full cardiac workup, and was ultimately found to have multivessel CHD. In summary, the presence of mild dyslipidemia, high blood pressure, cigarette smoking, obesity, and a family history was sufficient to induce ischemic heart disease at such a young age. a. What lifestyle modifications would you recommend to this client? List 3 b. What does the cardiac workup (i.e diagnostics or labs) consist of? List...

A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented...

A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented to an internist complaining of a cough and wheezing. The patient had immigrated to the United States from Ecuador several years earlier, and she spoke mainly Spanish. She lived with her son, who had been in the U.S. longer, spoke English fairly well, and worked as a computer technician. The son had sometimes come to medical visits with the patient in the past, but...

Define the term acute coronary syndrome and distinguish among chronic stable angina, unstable angina (UA), non-ST–segment...

Define the term acute coronary syndrome and distinguish among chronic stable angina, unstable angina (UA), non-ST–segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) in terms of pathology and symptomatology.

Your patient is an active 80-year-old woman with heart failure and chronic atrial fibrillation. You are...

Your patient is an active 80-year-old woman with heart failure and chronic atrial fibrillation. You are taking an angiotensin-converting enzyme inhibitor, a beta-blocker, a diuretic, and digoxin. During her evaluation, she tells him that she felt very dizzy this morning. How would you approach your evaluation and why? Identify some of the key evaluation factors. What nursing interventions are necessary? How would you change your evaluation and interventions if your patient also had chronic obstructive pulmonary disease and kidney failure?

The history describes your patient as a 38-year-old married woman, the mother of two children in...

The history describes your patient as a 38-year-old married woman, the mother of two children in the sixth and eighth grades. She works full-time as a paralegal professional. Her past medical history is listed as a tonsillectomy at age 8 years and a urinary tract infection at age 14 years (none since then). She has sought healthcare at this clinic for the last 2 years and had a comprehensive assessment when she entered the system. Her husband says that she...

Question