Q1) Clinical features that John is representing which made him undergo the diagnosis of cardiac ischemia are the sudden occurrence of chest pain along with breathlessness, numbness in the left hand, and along with tingling. After being diagnosed by a doctor, he stated that he observed breathlessness at times when he went through certain exertions. Information his case, that indicate a diagnosis of cardiac ischaemia are the pulse rate that is 90 per minute where the arteries are stiff on palpitation. The rate of respiration was also 19 per minute which has actually increased due to exertion. The cholesterol was also high of around 8.3 mmol where the normal rate lies under 5.5 mmol which is the contributing factor. The doctor have shown that John has many blockages in the coronary arteries which made him undergo through cardiac ischemia (Healthgrades Editorial Staff, 2020)
Q2) Non-cardiac chest pain is defined as a term that is used for describing pain in the chest which has not been caused due to heart disease or any kind of heart attack. In most of the people, the non-cardiac pain arises due to the oesophagus problem like that of gastroesophagealreflux disease. The other causes involve muscle or problems in the bone, problems in the lungs or diseases, problems in the stomach, stress anxieties, and depression (HealthDirect, 2020).
Some people have reported that the pain occurs in such a higher amount that it often spreads to the neck, left arm, and back. The pain might last for some hours or minutes. The muscle problems are known as oesophageal motility disorders where the presence of abnormal muscle activity in the oesophagus prevents food in moving. The muscle problem involves lack of coordination between the muscle contractions and also missing contractions which have been resulted by the loss of nerve.
Anxiety: The chest pain associated with anxiety involves shooting pain, unusual muscle twitch, or chest spasm along with chest tension and tightness.
Depression: It is linked with heart disease. A person who undergoes some stress or having panic attack, certain hormones like cortisol gets secreted as a part of the fight response and these kid of hormones actually triggers certain physical symptoms like chest pain associated with rapid heartbeat.
Emotional stress: In this case, the pain is like an unusual muscle twitch or chest spasm. In addition to this, chest tightness is also getting created along with numbness or burning.
Diabetes: The individuals suffering from Type 2 diabetes often undergoes through silent heart attacks which causes problems like numbness, weakness in the hands, tingling etc.
Hypertension: In the context of pulmonary hypertension, the increased amount of blood pressure in the blood vessels creates chest pain and also creates difficulties in breathing.
Hyperthyroid: Hyperthyroid associated with clogged coronary arteries and it experiences chest pain like angina which occurs when the narrowed coronary arteries cannot able to carry the extra blood which the heart muscle demands.
Bone problem: Again the type of chest pain related to bone probes is the constant dull pain or chest aching which occurs at the junctions where ribs meet the sternum. This is called costochondritis (ClevelandClinic, 2020).
Q3) Angina pectoris is known as one medical term or the type of discomfort due to coronary heart disease (BetterHealth, 2020). It generally develops when the heart muscle generally lacks in receiving adequate blood as it requires. This actually happens since one or more of the arteries of the heart gets narrowed or blocked (Albrecht, 2013).
Angina pectoris actually occurs due to the presence of flatty substance called plaque which located themselves in the arteries and hence blocks the blood to flow in the heart muscle. This forces the heart to work with a lesser amount of oxygen. Hence due to this, the pain generally occurs (ClevelandClinic, 2020). In this situation, the individuals might face blood clots in the heart arteries which can lead to heart attacks. The other causes of angina pectoris involve blockage in the majority of the artery in the lungs and also enlarged or the thickened heart. It also involves the narrowing of the valve in the main part of the heart and also the swelling of the sac around the heart (Czerny & Victoria, 2020,p.410). The other cause involves tearing in the wall of aorta which is one of the largest artery in the body.
Q4) The pathophysiology behind unstable angina is the flow of blood which gets impeded to the myocardium. Generally, this kind of blockage can get started from the formation of intraluminal plaque and also the existence of intraluminal thrombosis along with elevated blood pressure (Moran & Forouzanfar, 2014,p.1494). On the contrary, stable angina pectoris is one of the common manifestations of myocardial ischemia. It generally occurs when the demand for oxygen in the heart gets exceeded the supply.
There exist three factors through which the myocardial oxygen gets demanded that is the rate of heart, intramyocardial wall tension, contractility, etc. Stable Angina Pectoris gets characterized by chest pain which generally occurs due to the emotional stress (Zouridakis & Avanzas, 2004,p.1750). The pain might get radiated to the jaw, arm on the left side as well as also on the shoulder. The patients with Stable Angina Pectoris often suffered from severe anaemia and also suffers from a lack of supply-demand oxygen balance.
Pathophysiology- In case of stable angina pectoris , oxygen gets delivered to the heart through large surface vessels which gets branched out into capillaries. In a healthy heart , the occurs little resistance in the blood flow of the epicardial vessels.
Q5) If individuals like John have an excess amount of the LDL in the bloodstream, then certain waxy plaques can be developed along the walls of the artery leading arteries to be narrower. With time, arteries might get damaged with these forms of plaques and it is also susceptible to certain blood clots (Zouridakis&Avanzas, 2004, p.1751).
The presence of blood clots in the heart can lead to a heart attack. Triglycerides get attached with lipoprotein particles in the blood which can be one of the independent risk factor for the occurrence of coronary heart disease (Djordjevi&Vladan, 2011,p.10).
Q6) The management strategies to treat angina pectoris re as follows:
Q1) Anthony represents signs and symbols like he is currently taking Asmol of around 90 mcg via the aerosol puffer so that his condition can get managed. He has displayed cold symptoms after arriving at his home. Since then, the condition of the patient gets worsened and he was also complaining regarding malaise, dull headache, sore throat as well as dry cough. He was also suffering from shaking chills and this is the reason, his cough got worsened through which rust-colored sputum got produced. Anthony was also suffering from a fever. The other relevant information like signs of respiratory distress were also present among Anthony and at the same time shrinked chest muscles on the right side which turn out to be helpful to diagnose the illness of Anthony.
Q2) Apart from pneumonia, the other problems of Anthony that have diagnosed with are malaise, dull headache, and mild sore throat along with dry cough. These have been selected since through certain observations like signs of respiratory distress, herpetic lesion on the upper lip are some of the results which contributed towards these selections (BetterHealth, 2020). The differential diagnosis for asthma involves chronic obstructive pulmonary disease, congestive heart failure, vocal cord dysfunctions etc.
Q3) The illness which Anthony have complained of are the malaise, dull headaches, sore throat, etc. The factors responsible behind malaise are stress, poor diet, the lack of sleep which worsens malaise (Healthgrades Editorial Staff, 2020). The causal factors of malaise is antibacterial infections, lung diseases, connective tissue diseases, etc (Webmd, 2020).
Q4) Pneumonia can be defined as the lung infection where the prime causes are bacteria and viruses (HealthDirect, 2020). The other cause of pneumonia is fungi particularly for those people whose immune systems not work properly. Pneumonia can be found life-threatening among the babies, young children and the elderly.
Certain signs of pneumonia are the cough, fevers, loss in appetites, etc (BetterHealth, 2020). If an individual suffers from pneumonia, then alveoli in one or both of the lungs get filled with pus and fluids which gets mixed with the gas exchanges which is sometimes known as consolidation and collapse of the lung (Healthgrades Editorial Staff, 2020).
According to the Department of Health, Australia, 2017 common infections like pneumonia are the primary reasons behind occupying the hospital bed. The annual incidence of Community-Acquired pneumonia stands out to be 245.3 per 100,000 person-years and the number of admissions was 479 and the patents, 465. The annual incidence per 100,000 person-years was 79.7 and the mean value of the patient’s age was 69.8 years (Australian Government Department of Health, 2017)
Q5) Differences in blood count among the patient shows that the patient might be allergic or might have a problem in the respiratory tract. The level of oxygen inpatient is also less which can be proved from the level of pH that is 7.40.This is also the reason behind the high range of Eosinophils. The results of patient’s condition are as follows:
Neutrophils 11000 (75%) 7700 – 8250 (60-65%) Eosinophils 1000 (7%) 110 – 220 (1-4%) Basophils 30 (0.6%) 0-110 (0.5-1%) Lymphocytes 2500 (30%) 2200-2750 (20-40%) Monocytes 470 (3.1%) 330 -550 (2-8%) Platelets
The alternative tests which are important for the patient to arrive at definite diagnosis are making the chest X-ray to check the condition of lungs, breathing test, measuring oxygen of the patient through Oxypulsemeter. Also the pneumonia test is also important that is the H1N1 virus test (Healthgrades Editorial Staff, 2020).
Q6) To treat asthma in hospitals, the patient like Anthony should be provided with short-acting inhaled beta 2 agonists along with anticholinergic. These type of drugs expands the passageways into the lungs. Also, the other medicines and treatment include the consumption of cromolyn sodium, inhaled corticosteroids, immunomodulators (HealthDirect, 2020). These are some of the medicines which be taking daily can reduce airway inflammation and also help in removing the control of asthma. Immunotherapy is also important in this section where Allery shots and sublingual tablets are important to control asthma. The other treatment involves Prednisolone 37.5-50mg/day for 5 days with regular reviews along with regular inhaled preventer at the time of discharging patients from hospital (ACAAI, 2020).
ACAAI. (2020). Asthma Treatment. Retrieved from Overview: https://acaai.org/asthma/asthma-treatment
Albrecht, S. (2013). Cardiovascular. Retrieved from The Pathophysiology and Treatment of Stable Angina Pectoris: https://www.uspharmacist.com/article/the-pathophysiology-and-treatment-of-stable-angina-pectoris
Australian Government Department of Health. (2017). Community-acquired syndromes causing morbidity and mortality in Australia. Retrieved from Abstract: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4101g.htm
BetterHealth. (2020). Pneumonia. Retrieved from Symptoms of pneumonia: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pneumonia
ClevelandClinic. (2020). Non-Cardiac Chest Pain . Retrieved from What is non-cardiac chest pain?: https://my.clevelandclinic.org/health/diseases/15851-gerd-non-cardiac-chest-pain
Czerny, M., & Victoria , D. (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European heart journal, 41(1), 407-477. doi:https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehz425#supplementary-data
Djordjevi, ́. B., & Vladan, ́. (2011). Lipoprotein(a) Is the Best Single Marker in Assessing Unstable Angina Pectoris. Cardiology Reserach aand Practice, 11(3), 1-13. doi:10.4061/2011/175363
HealthDirect. (2020). Pneumonia. Retrieved from What is pneumonia?: https://www.healthdirect.gov.au/pneumonia
Healthgrades Editorial Staff. (2020). Malaise. Retrieved from Introduction: https://www.healthgrades.com/right-care/symptoms-and-conditions/malaise
Jamshid, A. (2018). Angina Pectoris. Retrieved from Practice Essentials: https://emedicine.medscape.com/article/150215-overview
Moran, A. E., & Forouzanfar, M. H. (2014). The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation, 129(14), 1493-1501. doi:https://doi.org/10.1161/CIRCULATIONAHA.113.004046
Webmd. (2020). Angina (Ischemic Chest Pain). Retrieved from Angina Symptoms: https://www.webmd.com/heart-disease/heart-disease-angina#2-4
Zouridakis, E., & Avanzas, P. (2004). Markers of inflammation and rapid coronary artery disease progression in patients with stable angina pectoris. Circulation, 110(13), 1747-1753. doi:https://doi.org/10.1161/01.CIR.0000142664.18739.92
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