You will perform a history of a cardiac problem that your instructor has provided you or one that you have experienced, and you will perform a cardiac assessment. You will document your subjective and objective findings, identify actual or potential risks, and submit this in a Word document to the drop box provided. Submit your completed assignment by following the directions linked below. Please check the for specific due dates.
Title: A Comprehensive History and Assessment of Cardiac Problems
Introduction:
Cardiovascular diseases (CVD) remain one of the leading causes of mortality worldwide. As a student, it is crucial to understand and apply a systematic approach when assessing patients with cardiac problems. This report aims to explore a comprehensive history of a cardiac problem, conduct a thorough cardiac assessment, document subjective and objective findings, and identify actual or potential risks. The case study assigned by the instructor will serve as the basis for this analysis.
Case Presentation:
The case involves a 55-year-old male patient who presented to the emergency department with complaints of chest pain, shortness of breath, and fatigue. The patient reports that he has a family history of heart disease, with both his parents suffering from myocardial infarction. He also admits to smoking one pack of cigarettes per day for the past 30 years and consuming a diet high in saturated fat and cholesterol. The patient is hypertensive and has a body mass index (BMI) of 30, indicating obesity.
Subjective Findings:
Subjective findings refer to the information provided by the patient regarding their symptoms, medical history, and lifestyle habits. In this case, the patient reports experiencing chest pain, characterized as a burning sensation radiating to his left arm, accompanied by shortness of breath and fatigue. He notes the pain is exacerbated by physical activity and relieved by rest. These symptoms correspond to typical angina pectoris.
The patient admits to smoking one pack of cigarettes per day, which is a significant risk factor for developing cardiovascular diseases. Furthermore, his family history of heart disease, coupled with a diet high in saturated fat and cholesterol, further increase the risk for cardiac problems. Moreover, the patient’s BMI of 30 suggests obesity, which is associated with an increased risk of hypertension and CVD.
Objective Findings:
Objective findings involve the measurable data obtained through physical examination, laboratory tests, and diagnostic procedures. In this case, the patient’s vital signs reveal an elevated blood pressure of 150/90 mmHg and an increased heart rate of 90 beats per minute. Physical examination reveals a slightly overweight patient with central obesity. Auscultation of the heart reveals regular rhythm with no murmurs, rubs, or gallops.
Diagnostic Tests:
To further evaluate the patient’s cardiac status and ascertain the presence of any underlying pathology, several diagnostic tests may be conducted.
1. Electrocardiogram (ECG): An ECG measures the electrical activity of the heart and assesses for any irregularities or abnormalities in the cardiac rhythm. It can identify signs of ischemia, infarction, or arrhythmias. Given the patient’s chest pain and symptoms, an ECG is essential for diagnosing potential myocardial ischemia or infarction.
2. Echocardiography: Echocardiography utilizes ultrasound waves to generate real-time images of the heart. It assesses the structure and function of the heart, including the size of the chambers, the functioning of the valves, and the overall contractility of the myocardium. Echocardiography aids in identifying any structural abnormalities or impaired cardiac function.
3. Stress Test: A stress test evaluates how well the heart functions during exercise. By monitoring the patient’s electrocardiogram and blood pressure while they engage in physical activity, a stress test can detect ischemia and assess the overall cardiac fitness. Given the patient’s symptoms worsening with exertion, a stress test can provide valuable information about potential ischemia.
4. Blood Tests: A comprehensive panel of blood tests is crucial for evaluating cardiac health. These tests include lipid profile assessment, such as measuring total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels. Other relevant tests include cardiac biomarkers like troponin, which indicate myocardial injury or ischemia.
Conclusion:
This thorough history and cardiac assessment of a patient with potential cardiac problems provide a comprehensive understanding of the patient’s subjective and objective findings. By assessing the patient’s risk factors, symptoms, and conducting the appropriate diagnostic tests, healthcare professionals can diagnose and develop an effective treatment plan tailored to individual needs. Early detection and intervention are paramount in reducing morbidity and mortality associated with cardiovascular diseases.