Kelley went to the Emergency Room complaining of chest pains and shortness of breath.

CRITICAL THINKING:

1) Kelley went to the Emergency Room complaining of chest pains and shortness of breath. Her ECG results were normal, and she was released with the instruction to make an appointment at your office within a week. The physician has ordered stress testing for Kelley, but she tells you that her symptoms have passed and she doesn’t want to do it. What can you say to convince her to follow the doctor’s orders?

2) Why are patients asked to record all activities and emotional states and the time of their occurrences in their Holter monitor activity diaries?

3) Michael has arrived for his second visit near the end of the day’s office hours. He does not have an appointment, but claims to be suffering from extreme back pain. On his last visit he was given a prescription for an opioid analgesic. He says that he is new to the area, his records from his previous physician have not arrived at your office, and when asked for contact information, he promises instead to contact the office himself when he gets home. How would you handle this situation

Expert Solution

1. Chest pain and shortness of breath occur due to decrease blood flow to heart result from atherosclerosis, coronary artery spas and it is temporarily present. Chest pain is the sign that may increase the risk of heart attack. There are many types of chest pain ( angina ), stable angina occur with activity or emotional stress and it will be relieved with rest or nitroglycerin, unstable angina occur with unpredictable degree of exertion or emotion and it occurence and duration, severity increase over time, variant angina occur at rest due to coronary artery spasm. So the chest pain may get relieved over time but there is a chance of risk of heart attack, to rule coronary artery disease and heart activity stress test to be done. Stress test is a non invasive test studies the heart during physical activity and detect and evaluate coronary artery disease. Even though you don't have symptoms at present you need to undergo stress test to evaluate coronary artery disease.

2. Holter monitoring is a noninvasive test were patient wear monitor and electrocardiographic tracing is recorded continuously over a period of 24 hours or more and the patient are instructed to record their activities or emotional states of daily living. This record will helps to identify the abnormal electrocardiographic tracing by correlating the time of activity or symptoms with the electrocardiographic tracing.

Nightingale answered 2 years ago

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