EVANGELISTA, PIA VEREA D.

March 18, 2010

BSN 3N Ms. Judith Cartagena, RN, MAN

CASE STUDY: ASSESSMENT OF THE CARDIOVASCULAR SYSTEM

Your client is, a 72 year-old man who had an extensive left ventricular
myocardial infarction (MI) at the age of 36 years. At the time of his MI, he
was overweight by 50 pounds and smoked two packs of unfiltered cigarettes
per day. He had smoked for twenty years. Alcohol consumption was a part of
his ethnic background; it was customary for him to drink one or two beers
per day and several mixed drinks per day. His father had also suffered an MI,
at the age of 48, and was a chain smoker. Your client slowly recovered from
MI, gave up smoking, and lost weight. His weight stabilized within 15 pounds
of the upper limit of his ideal weight. His wife became an active participant in
his recovery by changing her style of cooking and virtually eliminating
saturated fats from their diets. He no longer drank beer, but he continued to
consume an average of two mixed drinks per day. He began a moderate
exercise program that included walking several kilometers a day at least
three times a week. He has had stable angina for many years and has annual
physical checkups and ECGs at the cardiologist’s office. He took up the
hobby of downhill skiing at the age of 66 with his cardiologist’s approval. He
is aha retired accountant with type A personality. Over the past 6 months, he
has experienced infrequent periods of light-headedness. He has “blacked-
out” on at least one occasion and was unable to remember and details of
what happened. A second episode of loss of consciousness occurred on a
clear, cold winter day while he was skiing. He revived spontaneously. The
next day, he scheduled an appointment with his physician.

1. Which lifestyle changes decreased his risk status after his MI? Which
habits increased his risk status? ( 5 points)

The lifestyle changes that decreased the client’s risk status are:

• Cessation from smoking

• Lost weight from being 50 pounds of being overweight to 15

pounds of overweight.

• Change of diet: eliminating saturated fats with active

cooperation of his wife
 • Cessation from drinking beer

• Had a moderate exercise program: walking 7 kilometers a day

at least 3 x a week

• Annual physical checkups and ECGs at his cardiologist’s office

• Took a hobby of downhill skiing with his cardiologist’s

approval

The habits that increased his risk status are:

• Continued consuming an average of two mixed drinks per

day.

• Has Type-A personality

2. Compare and contrast the risk factors of CV disease for a 36 year old
man and a 72 year old man. (5 points)

72 yr. old man 36 yr. old man

Do not exhibit typical pain profile because of

diminished responses of
neurotransmitters that occur with aging

Dyspnea is the COMMON PRESENTING Chest Pain, chest

SYMPTOM discomfort, angina
pain

Atypical Pain – radiated to both arms Atypical Pain –

radiated just at the
left arm

SOMETIMES ASYMPTOMATIC SYMPTOMATIC:

Shortness of breath

Edema

Weight gain

Palpiations

Fatigue
 Dizziness

Syncope (fainting)

PHARMACOLOGIC STRESS TEST is used to EXERCISE STRESS

mimic effects of exercise by maximally dilating TESTING wherein the
the coronary arteries patient walks on
treadmill or pedals a
e.g. generic names: Dipyridamole and
stationary bicycle or
Adenosine given drugs to vasodilate the
arm crank.
coronary arteries

3. The cardiologist performs an ECG and orders blood drawn for AST, CK,
and CK-MB, LDH, and isoenzymes, and serum potassium. Discuss why
there is reason for concern. (5 points)

• ECG – to detect dysrhythmias and monitoring of electric

conduction of the heart

• AST – above suspected threshold

• CK and CK-MB – Creatinine kinase and Myocardium are the

enzymes that are first to increase after acute Myocardial
infarction

• LDL level- primary transporters of cholesterol and triglycerides in

to the cell. Increase in LDL level depositions more substances in
the artery wall.

• Serum K+ (Potassium) – HYPOKALEMIA: causes dysrhythmias,

ventricular tachycardia-ventricular fibrillation (both life
threatening) and also predisposes toxicity of Digitalis.
HYPERKALEMIA: causes heart block, asystole and ventricular
dysrhythmias (life threatening)

4. The ECG and blood work are inclusive, but the physician is concerned
about his symptoms. Discuss why there is a reason for concern. (5
points)

Lightheadedness is not a symptom of MI. It may indicate CVD

comorbidity.
5. He is scheduled for an in-patient cardiac catheterization. The physician
tells him that based on the findings at the time of catheterization; he
may go ahead and perform an angioplasty. Develop a teaching-
learning plan for this client.

6. The cardiac catheterization is completed and a 95% blockage of the

left anterior descending (LAD) artery is seen along with an 80%
blockage of circumflex artery. A balloon angioplasty is performed in
the catheterization laboratory. After the procedure, the LAD has 40%
blockage, and the circumflex artery had 25% blockage.

What do these findings mean? What significance does the residual

blockage have for this client? (10 points)

7. The physician counsels the client to resume activity gradually. a stress

test will be scheduled within several weeks for further evaluation of his
exercise tolerance and cardiac status. (5 points)

8. Develop a teaching-learning plan for this client to prepare him for the
upcoming tests. (5 points)