Diagnostic Essay Example
Ms. P. J. is a 65 year old presenting with complaints of nausea and epigastric pain who was found to be unresponsive by a family member. The patient’s prior medica history consist of hypertension, hypercholesterolemia, and diabetes mellitus type II. On examination, the patient appears pallor and is cold to the touch. With further examination, the patient is tachypneic with a weak pulse and palpitations. She is also hypotensive although it was reported that patient was hypertensive the day prior. Pertinent to her medical history, the patient’s social history is quite remarkable. She lives a sedentary lifestyle and a heavy smoker of 45 years.
A silent myocardial infarction occurs due to a rupture of unstable atherosclerotic plaques with obstruction of the coronary arteries. Psychosocial risk factors such as smoking, unhealthy diet, lack of exercise and pre-existing medical conditions can make one susceptible to a myocardial infarction. Ms. Johnson presented with several of these risk factors such as leading a sedentary lifestyle, smoking, and a prior medical history of diabetes and hypertension which put her at elevated risk. Invariable factors such as age, se, family history and genetic disposition of familial hypercholesterolemia can also play a significant role in causing myocardial infarctions.
A diagnosis of silent myocardial infarction is creating by integrating the history of the presenting illness and physical examination with a complete blood count, cardiac enzyme, glucose levels, lipid enzyme, EKG, and cardiac catheterization. The results of a complete blood count can be used to rule out various blood disorders such as anemia and blood clots which can contribute to or worsen heart failure. A cardiac enzyme study is used when a myocardial infarction is suspected. One can expect elevated markers due to the damage sustained by the heart muscles. High admission glucose levels are normal after a myocardial infarction especially when the patient was previously diagnosed with diabetes. Patients with diabetes are at elevated risk for cardiac disease and may continue to show elevated glucose levels. A lipid panel measures the levels of lipid in the blood. Abnormal lipid levels can cause lipid deposition in the artery wall leading to a myocardial infarction. Lastly, an EKG and a cardiac catheterization both help determine heart health and are used to diagnose heart conditions.
Differential diagnoses include pulmonary embolism, pulmonary hypertension, cardiogenic shock, myocarditis, and aortic dissection. Complications of myocardial infarctions include arrythmia, cardiogenic shock, congestive heart failure and thromboembolism.
Heart valvular disorders can be congenital or caused by heart disease or infections causing one or more of the heart valves to work incorrectly. Examples of heart valve problems are regurgitation, stenosis, and atresia (Mayo Clinic, 2021). If a valve is unable to function properly or fails to open and close per heartbeat, blood flow to the heart is disrupted. This can severely hamper the heart’s ability to function properly and lead to heart failure. Patients with damaged heart valvular disorders are at higher risk for endocarditis, an inflammation that occurs in the heart valves. This occurs when infection or bacteria travel to the heart and spread across the lining of the endocardium.
Shock is a life threatening condition that occurs when the body does not receive adequate blood supply (Heller, 2018). There are four types of shock. These include hypovolemic, cardiogenic, anaphylactic, and septic shock. Septic shock is caused by infection that causes a significant drop in blood pressure. Septic shock is life threatening and can be difficult to treat. Complications associated with septic shock include cardiac failure, kidney failure, respiratory failure and death. Cardiogenic shock is another life threatening condition caused by a sudden disruption in the heart’s ability to pump blood. This disruption leads to decreased cardiac output and tissue hypoxia. It is the leading cause of death in acute myocardial infarction cases (Ren, 2019). Hypovolemic shock occurs as a result of loss of blood volume. It occurs when the body loses a high amount of salt and water. Patients with severe hypovolemia shock can lose up to 40% of the blood volume, leading to mental distress, restlessness, pale skin, vomiting and a weak pulse. Anaphylactic shock is a severe allergic reaction that can be deadly. Anaphylaxis causes the body to release chemicals that can cause the body to go into shock. It can occur within seconds and is characterized by a weak pulse, skin rash, nausea, and vomiting. Triggers include foods, medications, and latex.
Chronic Obstructive Pulmonary Disease or COPD is the fourth leading cause of death in the United States. With COPD, air flow is blocked from entering the lungs and bloodstream COPD can present as a nagging cough, shortness of breath, wheezing and chest tightness. It is primarily caused by smoking and irritants that are harmful to the lungs. The three common disease that can cause COPD include emphysema, chronic bronchitis, and asthma. Asthma is a form of obstructive lung disease characterized by airway hyperresponsiveness to external stimuli. It is characterized by dyspnea, cough, and episodic wheezing. Common causes of asthma include air pollutants, allergens, chemical fumes, and strong odors.
Pneumothorax refers to the presence of air in the pleural space of the thoracic region and results in a collapsed lung. This alters the pressure that keeps the lungs inflated. It can be caused by an open injury or trauma including complications from medical procedures such s mechanical ventilation. The signs and symptoms of a pneumothorax include sudden onset of sharp chest pain hypoxemia, dyspnea, chest tightness, and tachycardia.
