Introduction
The Eighth Joint National Committee (JNC 8) states that people between 30 and 59 years of age with blood pressure less than 150/90 mm HG do not require initiating therapy (James et al., 2014, p. 508). Sean M.’s BP is 136/84. It is higher than its ordinary norm which is 120/80. Still, it is hard to call Sean M. hypertensive at the moment.
Acute Myocardial Infarction
Acute myocardial infarction, unspecified (I21.9): is also known as heart attack, the condition when a person experiences a sharp and sudden chest pain (Thygesen et al., 2012, p. 2025). The main symptoms of a heart attack in addition to chest pain also include shortness of breath, sweat, fatigue, nausea, and dizziness. Sometimes, the signs could last for days and weeks. Sometimes, people experience the attack and forget about it in the next several days. Rationale: The patient got all those symptoms and admitted that the discomfort in the chest lasted for about three minutes. Then, the pain was gone and never repeated.
Treatment Plan
Diagnostics
ECG: to observe the electrical activities of the heart and analyze the impulses that could be displayed (Thygesen et al., 2012, p. 2029).
Chest X-ray: to identify if there are some changes in the heart and chest that could lead to another attack or serious problems.
Medication: Rx: Atorvastatin 80mg (Amarenco, 2014, p. 2974) Sig. orally once a day: Disp # 30. Refill: not required.
This medication helps to prevent heart attacks and improve the level of cholesterol. Sean has a high level of TC.
Conservative Measures
Treatment for people who have heart attacks should include the use of medications, surgical procedures in cases of emergency, changes in lifestyle, and cardiac rehabilitation that should help to relax (Brown, 2014). The patient should decrease the number of physical exercises and avoid possible emotional changes.
Education
The patient should understand that hypertension is one of the main reasons why heart attacks happen. It is not enough to stay calm but also treat for hypertension as the main complaint (Thygesen et al., 2012, p. 2020). Healthy eating and a healthy weight could also help to prevent heart problems.
Referrals
The help of a professional cardiologist and dietitian could be offered in addition to the suggestions given by a primary care provider or a therapist.
Follow-Ups
The patient should visit a doctor in one month to report the condition and describe if similar attacks happen to him.
Chest Pain
Chest pain, unspecified (R07.9): is the condition when a person experiences problems with heart or lungs or panic attacks. It is hard to understand true reasons for chest pain, and the researchers identify costochondritis as one of the possible outcomes (Raza, 2014, p. 191). Therefore, inflammation of joints could lead to fatigue and shortness of breath. Rationale: Sean M. claims that he had a 3-minute experience of chest pain with a further inability to work hard and find enough energy to do his routine exercise. Besides, he seems to be in a panic because of the inability to comprehend the reasons for such pain.
Treatment Plan
Diagnostics
CTCA (Computer tomography coronary angiography) could be used to define the nature of chest pain that is of unknown origin (Ciampi, Rigo, Grolla, Picano, & Cortigani, 2015).
Twelve-level electrocardiography is used to test ST-segment changes caused by chest pain in adults (McConaghy & Oza, 2013, p. 177).
Medication: Rx: Aspirin, 81 mg Sig.: orally daily Disp # 30. Refill: 2 (Smith, Negrelli, Manek, Hawes, & Viera, 2015, p. 286).
Conservative Measures
The family should provide the patient with help and support to avoid or, at least, reduce the chances of chest pain. The possible suggestion includes the necessity to relax (McConaghy & Oza, 2013, p. 179) and spend more time outside to breathe in the fresh air and to enjoy nature. Proper diets are also appreciated.
Education
Chest pain is the diagnosis that is given to the majority of patients, who address chest pain. Such diagnosis provides doctors with an opportunity to continue diagnosing and taking all necessary tests. Therefore, the patient should be explained that it is not enough to take pain relief and expect that the complaint cannot be repeated. It is important to continue investigating and define a true reason for chest pain. Besides, it is important to keep a healthy style of life, choose a healthy diet, and decrease the nature of physical experiences (Smith et al., 2015, p. 285).
Referrals
A pulmonologist should be addressed to check if chest pain has a lung-connected problem. A cardiologist should help to identify the changes in the heart that could be observed after the case of chest pain. Finally, a rheumatologist should be visited to clarify if the patient has some problems with joints that could lead to problems with breathing for a certain period of time.
Follow-Ups
The next check-up should be done in one month in case no emergency makes the patient address the ER. It is enough to visit a therapist and report about the latest changes in the lifestyle and the outcomes of the medications offered.
References
Amarenco, P., Callahan, A., Campese, V. M., Goldstein, L. B., Hennerici, M. G., Messig, M.,… & Zivin, J. A. (2014). Effect of high-dose atorvastatin on renal function in subjects with stroke or transient ischemic attack in the SPARCL trial. Stroke, 45(10), 2974-2982.
Brown, C.H. (2014). Heart disease in women different than in men? US Pharmacist. Web.
Ciampi, Q., Rigo, F., Grolla, E., Picano, E., & Cortigani, L. (2015). Dual imagining stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin. Cardiovascular Ultrasound, 13(21). Web.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,… & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). The Journal of the American Medical Association, 311(5), 507-520.
McConaghy, J.R. & Oza, R.S. (2013). Outpatient diagnosis of acute chest pain in adults. American Family Physician, 87(3), 177-182.
Raza, S. (2014). PT147 Measuring Serum Vitamin D level as a part of evaluating patients presenting with Atypical Chest Pain. Global Heart, 9(1), e194-e195.
Smith, J. N., Negrelli, J. M., Manek, M. B., Hawes, E. M., & Viera, A. J. (2015). Diagnosis and management of acute coronary syndrome: An evidence-based update. The Journal of the American Board of Family Medicine, 28(2), 283-293.
Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., & White, H. D. (2012). Third universal definition of myocardial infarction. Circulation, 126(16), 2020-2035.