Unstable angina Advanced Clinical Diagnosis

Unstable angina is defined as a diagnosis that falls under the acute myocardial syndromes. The diagnosis of unstable angina is associated with cardiac ischemia that has no detectable myocardial necrosis (no detectable creatinine kinase, troponin, myoglobin in circulation) (Yu, Sun, Wang & Zhou, 2017). Unstable angina pectoris contrasts from stable angina pectoris in that in unstable angina, the occurrence of its symptoms occur at rest while the occurrence of symptoms in stable angina occur when there is an increase in oxygen requirements of the myocardium (Giustino et al. The primary diagnosis of unstable angina in Larry’s case is based on the patient’s history of presenting illness, physical assessment and history of the patient. Larry presents with a chest pain that occurred days ago when at rest.

Cigarette smoking increases the risk of developing coronary heart diseases as the toxins and chemicals used in cigarettes are smoked into the bloodstream. These toxins from tobacco and the chemicals lead to hardening of the arteries and scarring of arterial walls. This risk is significantly increased in individuals who use alcohol (Braunwald & Morrow, 2013). Larry also has a familial history of stroke (his mother passed on due to complications of stroke) this increases his likelihood of developing cardiac illnesses. The physical assessment of Larry indicates obesity which also is a key risk factor for coronary artery occlusion and hence the development of unstable angina. Larry EKG presents with an ST depression finding with no elevation in cardiac biomarkers which rules out the diagnosis of NSTEMI (Yu, Sun, Wang & Zhou, 2017).

ST elevation myocardial infarction (STEMI ): In STEMI the presenting symptoms are similar to those presented by Larry (chest pain, dyspnea, nausea) hence the rationale for its inclusion as a differential diagnosis. STEMI differential from unstable angina in that on EKG, in STEMI the ST wave is usually elevated in two leads or more while in unstable angina it is depressed. STEMI also presents with an elevation of cardiac biomarkers troponin and creatinine kinase which indicate cardiac necrosis unlike in unstable angina (Yu, Sun, Wang & Zhou, 2017). Relevant labs/diagnostic tests The laboratory/ diagnostic tests that are relevant to the case presentation by the patient include EKG. What leads demonstrate the ST depression The first part of the II wave and the Second II wave Secondary diagnosis Larry has a secondary diagnosis of hyperlipidemia which is characterized by obesity marked by a body mass index of 33.

4 with elevated total cholesterol levels, elevated low-density lipoproteins and a low level of high-density lipoproteins. The low levels of high-density lipoproteins (good cholesterol) and high low-density lipoproteins (bad cholesterol) present a high risk for Larry to develop heart diseases such as atherosclerosis, stroke and cardiac arrest (Hao and Friedman, 2014). The presence of a diagnosis of obesity puts him at risk of developing insulin resistance diabetes mellitus (type 2 diabetes) (Wu et al. Another secondary diagnosis for Larry is hypertension. Primary diagnosis management The management of unstable angina pectoris according to the American Heart Association (AHA), American College of Cardiology and the European Society of Cardiology (ESC), indicate that for patients presenting with unstable angina such in Larry's case, beta-adrenergic blockers such as metoprolol succinate can be administered in absence of heart failure (Whelton et al.

Initial intravenous metoprolol 5mg with 5mg increments every 1 to 2 minutes up to 15 mg should be initiated to assess the patient’s tolerance of the medication. Tolerance established oral beta blocker 25mg to 50mg is administered every 6 hours for 48 hours and then in patients who show tolerance, metoprolol 100mg twice daily maintenance dosing is feasible for administration (Whelton et al. Antiplatelet therapy is indicated by the AMA and ESC who identify immediate and continued use of Aspirin as a first choice for antiplatelet therapy (Amsterdam et al. Aspirin is a preferred medication as it provides better Plavix is a drug of choice in antiplatelet therapy efficacy as it combines the mechanism of action of two medications Aspirin and Clopidogrel. Patient education will also touch on the need for Larry to understand his medication regimen and how to manage the pill burden since he has other comorbidities.

Larry will be taught how to maintain a medication schedule and the possible drug interactions and side effects of the medications he will be taking. Larry will undergo counseling on dietary intakes and maintenance so as to ensure proper observation on diet and exercise to reduce the risks of cardiac attacks in the future. The referral needs for Larry include referral to a dietician for follow up on his nutrition intake and maintenance which is critical to his current diagnosis. There will be a need for further referral for a cardiology review and assessment of his presenting illness, diagnosis and follow-up during care. doi: 10. 1161/cir. 0000000000000134 Armstrong, C. JNC8 Guidelines for the Management of Hypertension in Adults. Retrieved from https://www.  Plos ONE, 9(3), e90497.