Potential Acute Coronary Syndrome: Anterior Myocardial Infarction - Case Study Example

Potential Acute Coronary Syndrome: Anterior Myocardial Infarction Student’s Name Student’s Number Institution Instructors Name Date TABLE OF CONTENTS TABLE OF CONTENTS 1 INTRODUCTION 2 Case Overview 2 DIAGNOSIS 3 Pathophysiology 3 Tests and Diagnosis 5 PARAMEDIC INTERVENTION CARE PLAN 6 CONCLUSION 8 REFERENCES 9 INTRODUCTION Cardiac disorders have been on the rise in the past decades threatening the well-being of the global population (Wong et al., 2013). Anterior myocardial Infarction (MI) also termed as heart attack is a common cardiac condition that occurs to people in their day to day activities. According to the Heart Foundation (2014) 8,611 lives were lost in 2013 due to heart attack with approximately 54,000 Australians suffering a heart attack every year. Prompt diagnosis and treatment of MI, is critical in ensuring reduction of fatalities from the cardiac ailment. This case study evaluates Bob, a patient with the MI syndrome by undertaking a substantive diagnosis, as well as the proper care, and how to effectively stabilize his cardiac well-being. Case Overview Bob is a 35 years old man in urgent need of paramedic care in the factory following his increased central chest pain that radiates into his jaw; his appearance is pale, calm, clammy and distressed. Despite not having experienced any chest pain before, Bob’s past medical history includes suffering from Asthma, GORD, Type II Diabetes that is diet controlled and HT, a connection of his sufferings. Bob is under medication for these conditions that include Sabutanol and Breo inhalers, paracetamol PRN, atenonol and omeprazole. He is allergic to penicillin medications, which means he cannot be prescribed to these antibiotics (Yeh et al., 2010). Bob’s social history indicates he lives with his partner, and his parents had died of chronic conditions; his mother of cancer and father died aged 41 from a heart disease. The health condition of this patient can be attributed to his drinking and smoking habits where he is reported of taking up to 30 cigarettes a day. In respect to communicable disease, there is no history and Bob is update with vaccinations. DIAGNOSIS In providing care to Anterior myocardial infarction clinical understanding of the condition is critical to providing quality care. The patient’s signs and medical history are critical in the overall diagnosis of MI. This is essential to establishing laboratory tests to employ in diagnosing the MI, tests that are identified through an extensive pathophysiology of the cardiac condition. The signs indicated by Bob are pointers to a serious cardiac problem and thus, the need for further lab test to ascertain the diagnosis of MI. The pathophysiology of MI is critically discussed below with consideration to signs presented by a patient. Pathophysiology Infarctions occur in different parts of the heart depending on the type of artery that is blocked. Blocking of arteries in the heart occurs as a result of blood clots. In this context, the right coronary artery is the one having occlusion resulting in the infarction of the right atrial. The tests using the ECG indicate changes in the P-Ta segment showing an infarct in the ventricle (Zafari and Yang, 2016). During MI, the ECG shows ST elevation or depression, or even pathological Q-waves are observed on the ECG. The ECG aids in identifying the occluded artery in the heart in order to come up with a treatment process (Wua, Wanga & Lind, 2010). This entails identification of heart tissue damages in a bid to establishing the most suitable intervention to correct the infarction (Hawrley, 2013). Figure showing an ECG indicating Acute Anterior MI (Source: Zafari and Yang, 2016) Vital signs are critical in the diagnosis of MI as it is considered that the ECG may at times appear normal even among patients suffering from a heart attack (Malik, 2011). High blood pressure, high blood sugars, high pulse rates and increased respiratory can be clear signs of a heart attack (Nedkoff et al., 2014). In context, the blood pressures are above 120/80, BGL above 100mg/dL and a pulse of more than 100bpm. Further, due to occlusion of the heart muscles, supply of oxygenated blood to body cells may be hampered which is indicated by low oxygen concentration in the blood, SpO2 of less that 95% (Barthel et al., 2012). Portraying severe prognosis, anterior myocardial infarction stands as the most serious coronary syndrome exposing a patient to great adversities. Caused by numerous factors, anterior myocardial infarction arises when the coronary artery inner walls blocks the flow of blood in the cardiac system (Nedkoff, et al., 2015). This causes blocking of blood to flow to other parts of the heart, depriving the cardiac muscles of oxygen resulting to their death, which is termed as infarction. The blockage often occurs in the areas that have high oxygen demand featuring low blood supply making it categorized as a ST-segment elevation MI denoted as STEMI (Ferreira et al., 2012). In this case under consideration, the affected part of the heart is the right atria. The damage, therefore, starts progressing outwards until it affects the whole part of the Myocardium at a point of the coronary artery (infarction). Anterior myocardial infarction is characterized by multiple cardiac attacks following the rising abnormalities in the cardiac system where approximately 10% of the victims die within the first year of diagnosis (Nedkoff et al., 2014). In most cases, the muscle damage shall translate into utmost pain in the chest of a patient that results in discomfort that may be felt jaws as depicted in Bob’s case. From the increased discomfort caused by the chest pain, the patient portrays fatigue symptoms with the pain being reported to last for over 30 minutes characterized by a deep arching pain in the chest that radiates to his jaw (Yeh et al., 2010). The fatigue can also be attributed to lack of efficient blood flow depriving the body cells of oxygen necessary for respiration (Yeh et al., 2010). This fatigue can be portrayed by the patient’s distress as seen in Bob’s case causing him to relax and show signs of anger from the pain distress. The discomfort thereby, affects the whole body resulting to a pale look and a diaphoretic skin as seen in Bob’s case. Tests and Diagnosis Concrete diagnosis of MI involves not just mere observation of these signs and indication. Tests and studying the history of an individual are highly imperative to diagnosing a patient with anterior myocardial infarction (Nedkoff et al., 2015). From the symptoms showcased by the patient, an evidence based assessment can be undertaken to ascertain the condition of the patient from which care can be administered. This is a physical assessment from which all the aspects of being are assessed (Menon, Lee & Eldenburg, 2011). Also the abnormalities can be effectively assessed through the electrocardiographic (ECG) transitions from which the patterns of the abnormalities can be established with any new anterior abnormalities being identified hence allowing initial care provision (Lee & Shim, 2012). This involves a 12 lead analysis as earlier indicated with respect to ECG analysis which results in showing the exact state of the infarction. Alongside the signs outlined, understanding the medical and social history of a patient is necessary for purposes of care management. In the paramedic guidelines, certain substances cannot be administered to certain patients abusing a number of drugs like Viagra. In this case smoking and alcohol presents prominently with Bob and thus, critical consideration is necessary to assess any interaction with the care plan to be devised. WHO (2013) reports that smoking stands to be a major cause of over 43% of Chronic Respiratory diseases globally with Europe being reported to have a higher prevalence of fatalities from tobacco smoking. Understanding such histories helps in coming up with an effective care plan for a paramedic, as well as in advising patients during recovery on their behavioral changes to embrace practices that promote proper health and well-being. PARAMEDIC INTERVENTION CARE PLAN The immediate paramedic intervention for Bob’s case involves services as per the South Australia Ambulance Services and the Clinical Practice Guidelines (2014). The first intervention involves taking the patient into the ambulance and stabilizing him via oxygen supply through a mask, followed by close monitoring as the patient is transferred to the hospital for emergency services. Immediate notification of receiving facility is necessary for preparation to cater for the emergency case (GSA, 2014). Maintaining the patient’s vitals are necessary while checking the breathing, pulse and blood pressure to ensure patient’s condition prior to actual tests upon reaching the hospital. The care plan as per the Paramedic Intervention will involve the following steps; Stage One: GTN- First due to the acute chest pains, oxygen and vasodilators are the primary treatments with critical care taken on the posture of the patient (GSA, 2014). Critical assessment of adequate blood pressure is necessary taking into account the systolic and diastolic blood pressures, the heart rate, mean arterial pressure and preload dependent ECG rhythms. In the event there is adequate blood pressure, rate and rhythm are appropriate, initiate GTN 400 micrograms SL. Aspirin 300mg is administered orally and then transport provided for further care in a hospital facility. If possible, consider conducting a 12 lead ECG in the event this does not interfere with treatment and transport of patient. Stage Two: If GTN and oxygen fails to provide sufficient pain control; Continue GTN as in stage one above and seek for clinical support. Failure of getting clinical support, consult the EOC clinician for morphine 1mg to 2.5mg IV in every 5 minutes PRN. Transport the patient while taking into consideration of patient posture. Notify the receiving facility if acute myocardial injury is suspected (SAAS and CPG, 2014). CONCLUSION In conclusion, confirmation of MI diagnosis established from the physical assessment and the ECG measurement to establish the existence of the condition is crucial (Malik, 2011). This shall be based on the physical assessment of Bob in relation of his medical history. Further, tests to confirm the cardiac functioning will provide conclusive findings to support the diagnosis. Nevertheless, of much importance is managing the patient during the emergency services which is carried out by the SAAS based on Clinical Practice Guidelines. These tenets provides essential care for the patient in the initial hours of emergency before transporting to the facility, as well as in the emergency department prior to full diagnosis in the first 24 hours. REFERENCES Barthel, P., Wensel, R., Bauer, A., Muller, A., Wolf, P., Ulm, K., et al. (2012). Respiratory rate predicts outcome after acute myocardial infarction: A prospective cohort study. European Heart Journal, 1-7, doi: 10.1093/eurheartj/ehs420. CDN (2016). CDN Radiology. Retrieved from . Ferreira, I.M., Brooks, D., White, J. and Goldstein, R. (2012). Nutritional supplementation for stable chronic obstructive pulmonary disease.Cochrae Database system Review doi:10.1002/14651858.CD0009. Government of South Australia (2014). Ischaemic chest pain guideline- Paramedic. Version 2 of 2. In CPG-005 Clinical Practice Guideline- Basci care and life support. Heart Foundation (2014). Heart disease in Australia. Accessed Online April 22, 2016 from . Lee, C.P., & Shim, J. P. (2012). An exploratory study of radio frequency identification (RFID) adoption in the Healhcare Industry. The European Journal of Information Systems 16(6), 712-724. Malik, M. (2011). Automatic tests to detect cardiac risk and their clinical practicality. J Cariovasc Electrophysiol, 22, 128-130. Menon, N. M., Lee, B., & Eldenburg, L. (2011). Productivity of Information Systems in the Healthcare Industry. Journal of Informatin System Research, 122-232. Nedkoff, L., Knuiman, M., Hung, J. & Briffa, T.G. (2014). Comparative trends in the incidence of hospitalized myocardial infarction and coronary heart disease in adults with and without diabetes mellitus in Western Australia from 1998 to 2010. Circ Cardiovasc Qual Outcomes, 7(5), 708-717. Nedkoff, L., Knuiman, M., Hung, J. & Briffa, T.G. (2015). Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010. Heart, 101(16), 1318-24. WHO (2013). Chronic respiratory diseases. Retrieved from World Health Organization: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/chronic-respiratory-diseases/data-and-statistics Wong, C.X., Sun, M.T., Lau, D.H., Broooks, A.G., Sullivan, T., Worthley, M.I., Roberts-Thompson, K.C & Sanders, P. (2013). Nationwide trends in the incidence of acute myocardial infarction in Australia, 1993-2010. Am J Cardiol, 112(2), 169-73. Wua, J.H., Wanga, S.C., & Lind, L.M. (2010). Mobile computing acceptance factors in the healthcare industry: A structural equation model. International Journal of informatics, (76), 66-77. Retrieved from . Yeh, R.W., Sidney, S., Chandra, M., Sorel, M., Selby, J.V. & Go, A.S. (2010). Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med, 362(23), 2155-65. Zafari, A.M. and Yang, E.H. (2016). Myocardial Infarction. Medscape. Accessed Online April 22, 2016 from . Read More