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Alterations of Cardiovascular Function
Charles Bennington, a 55-year-old carpenter, develops severe crushing substernal chest pain with dyspnea, dizziness, diaphoresis, and nausea while unloading plywood from a truck. He is admitted to the emergency department and states that his symptoms have not resolved in the 40 min since they began, and that they are still severe. He indicates that he has had milder episodes of chest pain in the past, especially in conjunction with strenuous work.
1. What is the pathophysiology behind Mr. Bennington’s prolonged chest pain?
2. Mr. Bennington’s blood pressure is low, he is tachycardic, and you hear crackles in his lungs. What is the pathophysiology behind these findings?
3. Mr. Bennington has acute coronary syndrome. Which two conditions does this diagnosis include?
4. Why is it important to obtain an ECG for Mr. Bennington as soon as possible?
5. Which blood studies could confirm the diagnosis of acute myocardial infarction?
6. As you examine Mr. Bennington after his ECG, why should you look for diminished pedal pulses and bruits?
7. Why is myocardial infarction more likely to occur in the left ventricle than in the right ventricle?
8. Mr. Bennington says, “Why did I get dizzy? The FNPs are focusing on my heart. Is there something wrong in my head also?” How should you respond?
9. Mr. Bennington was diagnosed with unstable angina. He asks, “What is unstable angina? How is that different from a heart attack?” How should you respond?
10. Why is it important for you to teach Mr. Bennington how to modify his risk factors for atherosclerosis?
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