Myocardial Infarction

 

• Discuss a brief HPI, Pertinent subjective and objective complaint data.
69 y/o male with known history of MI, CAD, HTN, Hyperlipidemia, Stent x2, obese. Presented to the ER via EMS from the local courthouse after feeling faint, weak, pale appearing, sob. On arrival patient saturation low 90s, tachycardic, SBP >160. Patient states “I feel some chest pressure, feels like the last heart attack started.” Denies chest pain radiates. Denies any headache, light- headed, dizziness, n/v/d.
HC: Troponin x2 elevated 0.9-1.0. EKG appears ST elevation leads V1-V2. Heparin drip started. Nitro x2 is given with chest pain relief. SBP 150-160. Sat 95% on 2L. Patient being transferred to the city for possible cardiac catheter/cardiology specialty services.
• Pick one disorder to explore related to the case and summarize the pathophysiology behind the disorder.
Myocardial Infarction
• Present the current management recommendations for the disorder. This must be based on current evidence or guidelines.
• Discuss the actual plan that was implemented in the clinical setting for this patient.
o Were guidelines followed? If not please explain further.
o When discussing the plan, address labs that were ordered, medications prescribed/ordered, referrals or consultations.
o Discuss WHY each of the components of the plan were implemented.

 

Myocardial infarction

Y​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ou have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty. He was started on Metoprolol for his consistently elevated high blood pressure during his hospital stay. His primary diagnoses include: Coronary Artery Disease Type 2 diabetes controlled with Metformin 1,000 mg BID and HgA1C of 6.7. Asthma- Mild Intermittent- with no recent episodes of wheezing. Albuterol INH as needed. All other pertinent labs Within Normal Limits First consider what clinical guidelines noted below can help us choose the best medication treatment for this patient with diabetes, CAD, Asthma and Hypertension. Joint National Committee JNC 8 – https://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf National Center for Biotechnology Information – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092891/table/T1/?report=objectonly American Heart Association – https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026 IHS Division of Diabetes https://www.ihs.gov/sites/diabetes/themes/responsive2017/display_objects​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​/documents/algorithms/AlgorithmHypertension.pdf Please answer each questions citing your response from evidence based clinical guidelines. Your response should not be post as “I would recommend”. Example of appropriate reference: The 2020 international Society of Hypertension Global Hypertension Practice Guidelines – recommend the use of selective ß1-receptor agonists in patients diagnosed with coronary heart disease and or heart failure ( Unger, T, et al, 2020). Reference: Unger T;Borghi C;Charchar F;Khan NA;Poulter NR;Prabhakaran D;Ramirez A;Schlaich M;Stergiou GS;Tomaszewski M;Wainford RD;Williams B;Schutte AE; (n.d.). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. : 1979). Retrieved August 1, 2022, from https://pubmed.ncbi.nlm.nih.gov/32370572/ Metoprolol is selective for which adrenoceptor? ( pharmacodynamics) What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics) In which organ is metoprolol primarily metabolized? (Pharmacokinetics) Why would a provider be cautious when ordering a Beta Blocker in a patient with A​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​sthma?