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Cardiovascular Case Study

Student Name

Institution

Course Name

Professor

Date
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Cardiovascular Case Study

1. What additional subjective data (list 5) would you collect? (10 points: 2 points for each

appropriate subjective data)

1) Location of chest pain and where does the pain radiate and at what time does the patient

begin to feel the pain for example during the day or night.

2) Breathing rate of the patient for instance easiness or difficultness in breathing.

3) When did the symptoms begin for instance time when the symptoms of chest pain fatigue

began showing up.

4) Which location does the patient feel indigestion discomfort.

5) If the patient feels dizziness

2. What additional objective data (excluding laboratory or diagnostic studies, list 5) would

you collect? (5 points: 1 point for each appropriate objective data)

1) Checking if the patient has bowel sounds in the abdomen

2) Collecting information on healthy eating habits of the patient

3) Check for heart sounds using a stethoscope to establish if the patient has heart rate,

rhythm, murmurs.

4) Inspecting skin color, swelling or signs of distress to see the general health of the patient.

5) Check for any crackles and labored breathing

3. List and prioritize differential diagnoses (list 4) you would consider. For each differential

diagnosis proposed, list specific information from the case study or from data you have
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suggested that supports the diagnosis. (20 points: 3 points for each appropriate

diagnosis, 2 points for each RATIONALE of diagnosis)

1) Coronary artery disease this is the most likely condition the patient may be suffering from

because the patient complains of chest pain, discomfort due to indigestion, always tired,

indigestion after eating, burping gas and the patient’s medical history reveals he has high

cholesterol.

2) Hypertension -the patients’ blood pressure is 166/88 which means he might be suffering

from hypertension stage 2, has chest pain and has a history of anxiety disorder.

3) Depression- the patient may also be having depression because he has chronic fatigue and

was earlier diagnosed with anxiety.

4) Postural orthostatic tachycardia syndrome- the patient may be suffering from POTS

because he has chronic fatigue, indigestion and chest pain.

4. What laboratory or diagnostic studies should be considered to assist with or confirm the

diagnosis and what would be the EXPECTED FINDINGS of these studies? (10 points: 5

points for appropriate studies, 5 points for expected findings of studies)

Diagnostic studies or laboratory test that should be done are CTA chest test. Computed

tomography angiography is an important tool in diagnosing patients with who have chest pain.

CTA can also be used as a tool for evaluation of coronary arteries, cardiac chambers and valves

(Goyal and Stillman, 2017).

Nuclear Stress Test may also be performed, it increases myocardial blood perfusion and

creates disparity in how the blood flows between normal and stenosed arteries. Healthcare
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providers are thus able to t see clearly if there are any regions of the heart muscles are ischemic

(Guptra and Samarany, 2022)

Doppler testing of the patient pulses, Doppler testing is used to estimate speed and blood

flow in major and minor vessels of the body (Oglat et al., 2018).

The expected findings from the three tests are to see the rate of blood flow, to see if

arteries and vessels are clogged and the structure of how the heart of the patient is functioning.

The tests will thus be appropriate in confirming if the patient has coronary artery disease.

5. Outline your treatment plan:

• Recommended prescription therapy: (10 points). - 5 points for appropriate prescriptive

therapy (including dosing) - 5 points for RATIONALE of therapy.

The appropriate prescription therapy for the patient is cognitive behavioral therapy and

CAD medications such as statins, aspirin, ACE inhibitors, angiotensin receptor blockers (Khatib

et al., 2019). The patient will be prescribed Statins for cholesterol, Aspirin for chest pain

management (75-100mg orally. The patient requires cognitive therapy as it is a psychological

therapy which seeks to change the behavior of the patient in order for him to avoid unhealthy

living habits that may have contributed to high cholesterol and blood pressure. Cognitive

behavioral therapy has provided effective health outcomes for patients with cardiovascular

disease such as coronary artery, it reduces depression, Body Mass Index levels, blood pressure

and enables patients to follow exercise routine (Li et al, 2021).

• Recommended non-prescription (OTC, complementary) therapy (list 2): (5 points) .1

point for each non-prescription therapy, including dosing, if applicable- - 1.5 points for

each RATIONALE of therapy

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Complimentary therapy shall include monitoring the cholesterol of the patient and

checking his eating habits including fiber intake. The reasons for the above complimentary

therapies are to ensure the patient cholesterol levels are not high and are at healthy levels to

avoid other heart diseases and severity of the coronary artery disease, and checking of eating

habits to ensure the patient does not take foods that have high intake of fats.

6. Propose referrals to other health care professionals and indicate the purpose (goal) of

the referral. (3 points: 1 point for appropriate referral, 2 points for RATIONALE of

referral)

First, referral to a nutritionist- I shall refer the patient to a nutritionist because the patient

is overweight, has high cholesterol levels. The patients’ needs to have education on eating

healthy and living healthy lifestyle. Second, referral to cardiologist for echocardiography to

examine how the patient’s heart is functioning. Echocardiography uses ultra sound waves to

give cardiac views of the heart and the main vessels, the cardiac views help in determining the

possible causes of cardiac arrest. (O’Rourke, Goldstein and Mendenhall, 2023). The cardiac view

will thus give more view on the heart arteries if they are blocked with cholesterol that is reducing

blood flow.

7. Describe patient/family teaching topics (list 3) that would be appropriate for this case. (3

points: 1 point for each DISTINCT and SPECIFIC topic)

1) The patient requires to be taught eating healthy habits and the family also needs to help

him get help from a nutritionist/ dietitian for reduction of the increased cholesterol level.

2) The patient needs to be taught on the importance of having regular exercise this will help

to reduce excess fat in the body that deposits in the arteries preventing the flow of blood.
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3) The patient also needs to be taught on maintaining a healthy weight. Maintaining healthy

weigh will prevent the patient from heart diseases that are brought with high body mass

level.

8. Identify any cultural, socioeconomic, religious or psychosocial issues (list 3) that you

have considered in your treatment plan. (3 points: 1 point for each DISTINCT and

SPECIFIC issue)

Income, spirituality and culture of a patient are important issues that one must consider in

their treatment plan as they may hinder effective treatment or health outcomes of a patient.

1) Income- Therapy treatment may be expensive for the patient in attending all the sessions

to completion hence I shall first consider the patients ability to pay for the treatment

before beginning the treatment plan.

2) Spirituality- I shall also make sure I involve the patient views on his spiritual views on

medical treatment since there are those religions that do not believe in treatment but Gods

healing power or see diseases as a punishment for their sins.

3) Cultural beliefs of the patient who is an African American. I will have to understand the

patient cultural beliefs that may hinder effective and complete treatment. There are some

cultures that do not believe in therapies as part of treatment this will help me in

considering the patients preferred treatment.

9. Case specific question(s). (3 points)

 What specific classes of antihypertensives might be most appropriate for this

patient

and why?
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The most used antihypertensives drug classes include angiotensin-converting enzymes

(ACE), angiotensin II receptor blockers (ARBs), diuretics, calcium channel blockers (CCBs) and

beta blockers (Nozari and Hamidizadeh, 2022). The specific classes of antihypertensives

appropriate for this patient may include calcium blockers to low the patients’ blood pressure,

diuretics to widen the patients’ blood vessels and allow easy flow of blood in the body as they

also help in reducing blood pressure levels. The patient may also use ARBs drugs as they will

help in relaxation of the patient veins, arteries and lower blood pressure for easier pumping of

the blood by the heart. The three classes may be effective in reducing the patients’ blood

pressure.

• When would you ask the patient to return to the office for a follow-up visit?

I will ask the patient to return to the office for a follow up visit when all medication have

been prescribed to monitor his progress in terms of blood pressure and cholesterol levels.

10. Identify preventative care that would be appropriate for this patient (immunizations,

screenings, etc.). (2 points: 1 point for appropriate preventative care, 1 point for

RATIONALE of preventative care)

The patient should follow a healthy diet and exercise regularly to help in reducing

cholesterol levels and high blood pressure.

11. Which Centers for Medicare & Medicaid Services Evaluation & Management (CMS

E&M) code would you assign this visit? Provide rationale for your answer. (1 point: 0.5

point for appropriate code, 0.5 point for RATIONALE of code).

I will assign ICD-10code 125.119. The patient has coronary artery disease with specified

chest pain.
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References

Goyal, N., & Stillman, A. (2017). Coronary CT Angiography in Acute Chest

Pain. F1000Research, 6, 1125. https://doi.org/10.12688/f1000research.11250.1

Gupta, A., & Samarany, S. (2022). Dipyridamole Nuclear Stress Test. In StatPearls. StatPearls

Publishing.

Khatib, R., Marshall, K., Silcock, J., Forrest, C., & Hall, A. S. (2019). Adherence to Coronary

Artery Disease Cecondary Prevention Medicines: Exploring Modifiable Barriers. Open

heart, 6(2), e000997. https://doi.org/10.1136/openhrt-2018-000997

Li, Y. N., Buys, N., Ferguson, S., Li, Z. J., & Sun, J. (2021). Effectiveness of Cognitive

Behavioral Therapy-based interventions on Health Outcomes in Patients with Coronary

Heart Disease: A meta-analysis. World Journal of Psychiatry, 11(11), 1147–1166.

https://doi.org/10.5498/wjp.v11.i11.1147

Nozari, F., & Hamidizadeh, N. (2022). The Effects of Different Classes of Antihypertensive

Drugs on Patients with COVID-19 and Hypertension: A Mini-Review. International

journal of hypertension, 2022, 5937802. https://doi.org/10.1155/2022/5937802

Oglat, A. A., Matjafri, M. Z., Suardi, N., Oqlat, M. A., Abdelrahman, M. A., & Oqlat, A. A.

(2018). A Review of Medical Doppler Ultrasonography of Blood Flow in General and

Especially in Common Carotid Artery. Journal of medical ultrasound, 26(1), 3–13.

https://doi.org/10.4103/JMU.JMU_11_17
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O'Rourke MC, Goldstein S, Mendenhall BR (2023). Transesophageal Echocardiogram.

[Updated 2023 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): Available from:

https://www.ncbi.nlm.nih.gov/books/NBK442026/