Case Study of Patient with
ACS_CAD_CABG.
Scenario
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing
coronary artery dis- ease (CAD) with occasional episodes of heart failure (HF). One
year ago, he had an anterior wall myocar- dial infarction (MI). In addition, he has
chronic anemia, hypertension, chronic renal insufficiency, and a recently diagnosed
4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to
retire from his job as a railroad engineer about 6 months ago. This morning, he is
being admitted to your telemetry unit for a same-day cardiac catheterization. As
you take his health history, you note that his wife died a year ago (at about the same
time that he had his MI) and he does not have any children. He is a current cigarette
smoker with a 50–pack-year smoking history. His vital signs (VS) are 158/94, 88,
20, and 97.2 ° F (36.2 ° C). As you talk with him, you realize that he has only a
minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him
the important things he needs to know before having the procedure. List five
priority topics you will address.
2. Look at his past history. What other factors are present that could
contribute to his risk for cardiac ischemia?
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report
shows 90% occlusion of the proximal left anterior descending (LAD) coronary
artery, 90% occlusion of the distal LAD, 70% to 80% occlusion of the distal right
coronary artery (RCA), an old apical infarct, and an ejection fraction (EF) of 37%.
About an hour after the procedure is finished, you perform a brief physical
assessment and note a grade III/VI systolic ejection murmur at the cardiac apex,
crackles bilaterally in the lung bases, and trace itting edema of his feet and ankles.
Except for the soft systolic murmur, these findings were not present before the
catheterization.
3. Using the following diagram, identify the superior vena cava, the aorta, and
the left and right ventricles. Identify the main coronary arteries, and circle the
areas of the LAD and RCA that have significant occlusion, as identified in the
previous report. Lightly shade the area of the heart where K.Z. had the earlier
infarct.
This study source was downloaded by 100000808565474 from CourseHero.com on 06-26-2021 10:40:43 GMT -05:00
https://www.coursehero.com/file/80401006/Case-Study-of-Patient-with-ACS-CAD-CABGdocx/
ACS_CAD_CABG.
Scenario
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing
coronary artery dis- ease (CAD) with occasional episodes of heart failure (HF). One
year ago, he had an anterior wall myocar- dial infarction (MI). In addition, he has
chronic anemia, hypertension, chronic renal insufficiency, and a recently diagnosed
4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to
retire from his job as a railroad engineer about 6 months ago. This morning, he is
being admitted to your telemetry unit for a same-day cardiac catheterization. As
you take his health history, you note that his wife died a year ago (at about the same
time that he had his MI) and he does not have any children. He is a current cigarette
smoker with a 50–pack-year smoking history. His vital signs (VS) are 158/94, 88,
20, and 97.2 ° F (36.2 ° C). As you talk with him, you realize that he has only a
minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him
the important things he needs to know before having the procedure. List five
priority topics you will address.
2. Look at his past history. What other factors are present that could
contribute to his risk for cardiac ischemia?
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report
shows 90% occlusion of the proximal left anterior descending (LAD) coronary
artery, 90% occlusion of the distal LAD, 70% to 80% occlusion of the distal right
coronary artery (RCA), an old apical infarct, and an ejection fraction (EF) of 37%.
About an hour after the procedure is finished, you perform a brief physical
assessment and note a grade III/VI systolic ejection murmur at the cardiac apex,
crackles bilaterally in the lung bases, and trace itting edema of his feet and ankles.
Except for the soft systolic murmur, these findings were not present before the
catheterization.
3. Using the following diagram, identify the superior vena cava, the aorta, and
the left and right ventricles. Identify the main coronary arteries, and circle the
areas of the LAD and RCA that have significant occlusion, as identified in the
previous report. Lightly shade the area of the heart where K.Z. had the earlier
infarct.
This study source was downloaded by 100000808565474 from CourseHero.com on 06-26-2021 10:40:43 GMT -05:00
https://www.coursehero.com/file/80401006/Case-Study-of-Patient-with-ACS-CAD-CABGdocx/
