Question

A 66 y/o female comes to the outpatient cardiac unit to have an exercise stress test performed in lieu of recent episodes of chest discomfort. She has a history of mitral valve regurgitation, hypertension, hyperlipidemia and tobacco use. Prior to the procedure, she presents with BP 145/89, HR 106, Temp 98.6℉, O2 sat 95%, RR 20. While on the treadmill, she develops chest discomfort and her EKG shows a ST elevation on at least two (2) contiguous leads.

1. What is your first action? Explain your rationale.

2. List 3 interventions you would implement in this situation. Explain your rationale.

3. What is the likely diagnosis? Explain your rationale.

4. This patient is likely to be admitted for further diagnostics. What diagnostic procedure(s) do you foresee being ordered? What information relevant to the client can be gained from the diagnostic procedure(s)?

5. How is a history of mitral regurgitation influential in this case?

6. Is this patient at risk for heart failure? Explain your rationale.

7. List 3-5 differences between left and right heart failure?

Answer 1

1,

The first action is taken during this period is stop the test and provide rest to the patient. Then administer analgesics as well as nitroglyceride to the patient in order to relieve the symptoms of chest discomfort as well as heart attack. This because of chest discomfort during TMT may indicate any heart deformity as well as may be the sign of heart attack.

2,

The interventions include provide rest and imobilize the patient to reduce the cardiac work load. Also administer nitroglyceride to reduce the work load of heart.

Administer morphine to reduce the pain, administer oxygen to maintain the oxygen saturation and also administer aspirin.

Monitor the ECG of the patient. Continous monitoring of patient's heart functioning is to monitor for any further damage.

3,

The diagnosis of the patient is may be myocardial infraction or heart attack. Rationale for this diagnosis is the patients ECG shows ST segment elevation, it indicates that or it cause is myocardial infraction.

4,

Diffrential diagnostic test such as X ray, ecg monitoring, angiogram, endocardiogram etc can be used to diagnose the MI.

Stress test or TMT is the more specific test. In ECG it shows ST segment elevation or depression, angiogram is also a management too.