Myocardial Infarction
Joe Hutchington, 53 yr. old male. Presented to the Emergency Department with central crushing chest pain, pain score 8/10, pale and sweating .Joe has a history of osteoporosis and is also insulin dependent type 2 diabetic.
He admits to being a pack a day smoker and drinks 3 red wine glasses a night to help him relax. He maintains 30 minute, exercise daily.
His vital signs on first presentation are:
Blood Pressure – 167/72
Respiratory Rate – 17
O2 – 97%
Heart Rate – 137 and arrhythmic
Blood Glucose Level – 6.2
Urine output – >30 ml PH
Capillary refill time – <2 seconds
Questions:
Symptoms
Q1) What is the most likely reason, Joes BP elevation?
The amount of sodium and other electrolytes are too high causing hypernatremia which in result is causing a raise in BP.
The Exercise may be a causing factor, as Joe, maintains active lifestyle.
Due to peripheral arteriole vasoconstriction, resulting from an adrenergic response to pain anxiety and ventricular dysfunction.
All the above
Rational
Q1)
Hypernatremia involves dehydration,
which can have many causes, including not drinking enough fluids, diarrhea, kidney dysfunction, and diuretics (James L. Lewis, III,2018) and is a good distractor for this question as it involves high salt in the blood, fatty and salty foods are common in people with MI although hypernatremia normally be followed by a drop-in BP.
As our patient has a normal amount of urine output hourly with a raise in BP and is showing no high cause for worry of Hypernatremia this is not the correct answer.
Joe maintains 30 minutes of exercise daily and although this can increase the BP for a short period of time should cause a long-term increase in BP and should slowly relieve itself (Blood Pressure Association, 2008). This is also a wrong answer as the BP is increased a while after excursive.
peripheral arteriole vasoconstriction resulting from an adrenergic chronic response to pain anxiety and ventricular dysfunction (C. Ayada et al, 2015). The narrowing of the coronary artery or heart disease where the dominant cause of heart failure and is normally the cause for acute or prior myocardial infarction.
The vasoconstriction and ventricular dysfunction of the coronary artery is there for the likely cause for a raise in BP (Paul W Armstrong, 2000)
All the above, gives an easy and common answer if the other answers are not read correctly or not understood.
Interventions:
Q2) … … … … … …… … …… … …… … …… … …?
a)
b)
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d)
Rational