Question

A 57 year-old male with history of HTN and HLP presents to your office with complaints of transient chest pain during exertion. He denies associated nausea, diaphoresis however does complain of increase shortness of breath and dyspnea on exertion. His chest pain is substernal and does not radiate and seems to alleviate after 5-10 minutes with rest. The last occurrence of pain was one week ago. Pt denies palpitations, near syncope or syncopal episodes.

1. How would you classify the patients symptoms? Support your answer and differentiate this from other presentations.

2. What would you order for this patient? Explain your reasoning.

The patient returns two days later prior to his outpatient testing and states that his chest pain had returned however now it is independent of exertion, is associated with diaphoresis, radiates to his jaw and continues to have shortness of breath.

3. Explain the pathophysiology of this progression of symptoms.

Answer 1

Coronary arteries ate supplying blood to our heart .when these arteries get blocked or narrowed blood supply to the heart is decreased or blocked, this can lead to chest pain ,also called as angina. This condition can also experience shortness of breath, and other symptoms are diaphoresis, nausea ,vomiting, palpitations, weakness etc..but it is vary person to person

1. This patient is having angina.Because angina is feel like a pressure or tightness in the chest.this can occur during physical activities or emotional stress.And it usually relieve with in few minutes of rest. Given scenario the patient feels same like this . This type angina called ad stable angina.

Also some patients may have angina even at rest ,no need of any perticular reason to have pain is called unstable angina. It can worse each episode. Sudden or severe blockage of blood flow to the heart muscle cause unstable angina.

2 .medicines

• . To this patient is having history of hypertension .so can order any anti hypertensive medicine , like betablocker and calcium channel blockers.
• Nitrates. will prevent angina .
• aspirin andantiplatlets help to reduce the ability of blood to clot.All these medicine to be prescribed by physician according to the investigation results.

3. This symptoms are common in myocardial ischemia .It happen ,when the oxygen supply to the heart is decreased .These pain feel like substernal chest pressure or tightness. It Slowly it radiating to arms, shoulder or jaw.it is because of inadequate blood supply to the myocardial tissues.inadequate blood supply occurs when coronary arteries are blocked or narrowed by fatty deposits called plaques .(Atherosclerosis)