History of Myocardial Infarction Discussion

History of Myocardial Infarction Discussion

Week 9 Case Study 2 Discussion Post
The case study patient is a 66-year-old female with a history of myocardial infarction, diabetes mellitus, hypertension, and hyperlipidemia. She developed dyspnea, diaphoresis, nausea, vomiting, and severe upper chest pain that radiated to her left arm. Her typical angina had begun to worsen nearly one month ago. Her electrocardiography revealed a depression in the ST-segment leads II, III, and  with hyperdynamic T waves. Her cardiac enzymes were positive. Symptoms of an acute myocardial infarction include diaphoresis, dyspnea, and nausea (Acute Myocardial Infarction, The six electrocardiograph (ECG) limb leads are leads   The leads that showed the depression in the ST-segment were the II, III, and  which are called inferior limb leads, because they primarily observe the inferior wall of the left ventricle (The ECG Leads, ). History of Myocardial Infarction Discussion Non-ST segment elevation myocardial infarctions (NSTEMI) and ST-segment elevation myocardial infarctions (STEMI) exist.

Assessing dietary management of cholesterol and diabetes would need to be addressed. A dietician referral might be appropriate. The patient may not have adequate management of her diabetes with Metformin 1 gram twice daily and other options, and even insulin may need to be added. In the future, after consulting with her cardiologist, a discussion about anticoagulant and antiplatelet therapy would need to be addressed. Aspirin is indicated for individuals who have a history of myocardial infarctions to help reduce the risk of a fatal myocardial infarction in the future (Rosenthal & Burchum, 2017). Metoprolol is indicated for myocardial infarctions. If the blood pressure stabilizes it would be appropriate to continue this medication.

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Trudie A Chin

Case Study 2:
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg daily. Her blood pressure today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
Around the age of 47, menopause starts, and it lasts typically for 5-8 years. My patient might be starting to encounter menopause symptoms. As a result of vasomotor symptoms, up to 80% of patients also experience them. Hot flashes and nocturnal sweats fall under this category. The exposure to estrogen follows by its absence is thought to be the cause of this. A test of serum FSH levels can confirm menopause.

Treatments:
Hormone therapy is the first line of defense for severe menopausal symptoms. Patients who have had breast cancer in the past are not advised to use hormone therapy. There is a danger that adding hormones could cause breast cancer to flare up again.
The use of particular SSRIs and SNRIs for vasomotor symptoms is supported by randomized trials. According to Roberts and Hickey (2016), clonidine, SSRI, SRNI, and gabapentin were more effective than placebo at reducing symptoms in 50–60% of patients. Hot flashes can be lessened with low doses of antidepressants including venlafaxine, sertraline, and paroxetine (Stubbs et al., 2017). Once a patient starts taking one of these drugs, they should be checked in a few months for evaluation and then once a year because the symptoms of menopause alter with time. History of Myocardial Infarction 

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Women who go through menopause may experience vasomotor symptoms in addition to bone loss and alterations in lipid metabolism. Studies on lipid metabolism have revealed rising LDL and falling HDL. According to Chai et al. (2002), this may raise a patient’s chance of developing cardiovascular disease. After a study in the early 2000s revealed a connection between thromboembolic events and an increase in breast cancer instances, the usage of hormone therapy decreased (Stubbs, et. al., 2017).

Regime Recommended:
Since my patient had breast cancer, I do not advise hormone therapy for her. Estrogen can also cause edema, and my patient, who already has HTN and is taking HCTZ 25mg, can suffer this. Low dose antidepressants can be used to address hot flash and night sweat symptoms. I advise my patient to begin with a modest dose and review after 4-6 weeks. Her history of ASCUS necessitates that she continues to have routine PAP smear tests. When this changes from positive to negative, a colposcopy should be performed.
With a blood pressure reading of 150/90, my patient is currently taking the maximum dosage of Norvasc. She is currently on a 25mg daily starting dose of HTCZ. We could raise her dosage to 50 mg, taking 25 mg BID, to help control her blood pressure. In order to determine her CVD risk when she enters menopause, I wish to advise that her cholesterol be evaluated on a regular basis.

Strategies Recommended:
According to studies, women who are overweight or obese who lose weight experience fewer hot flashes (Roberts, et. al., 2016). I wish to inform my patients about the value of exercise and a healthy, low-sodium diet. To cope with menopause symptoms, the authors also suggest yoga, behavior therapy, rest, and acupuncture. Before starting prescription meds for genitourinary symptoms, I would advise looking at over the counter (OTC) medications that can help. My patient must continue to get frequent mammograms, PAP smear tests, and blood pressure checks.

History of Myocardial Infarction Discussion

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