Case Study on Acute Coronary Heart Syndrome

Introduction

The disorder which affects the heart and blood vessels can be referred to as cardiovascular diseases. A variety of cardiovascular diseases include rheumatic diseases, coronary diseases that affect mainly the heart, among others. According to WHO, one of the major killer diseases in Scotland remains to be coronary heart diseases (2017). The latter has been evidenced by the statistics that have been offered by the Statistics board of Heart Diseases, regarding mortality rates. However, Scotland health board has been involved in crucial practices which are aimed at reducing the mortality rates associated with this cardiovascular disease. Despite these improvements made, coronary heart disease remains the leading killer disease in the country. According to a health survey done by Scottish Health Board, a total of six thousand six hundred and ninety-seven deaths was caused by coronary heart diseases in Scotland (2016). Generally, it can be estimated that approximately four per cent of women and seven per cent of men in Scotland live with coronary heart diseases. Prevention and treatment options for this epidemic remains to be the long-term objectives of the heart condition under study (Heart Disease Improvement Plan, 2014).

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The purpose of this report is discussing Mr Jim, who is a fifty-seven aged man seriously attending a clinic annually that deals with cardiovascular diseases at General Practice. During the year 2016, Mr Jim underwent a cardiac arrest in a football match which made him admitted to a hospital for inferior STEMI. The latter refers to an infarction which segments elevated and myocardial. The gentleman under study is an accountant and at the same time, married. His medical records show hypertension and depression cases which were however treated using thiazide diuretics. In addition to the previous cases, Jim has hypercholesterolemia which he could take care of by attending statin therapy, as advised by his primary health caregiver. The latter condition could be attributed to the fact that Mr Jim spends most of his time sitting in the office, despite him having an active lifestyle. 27.2 BMI, work-related stress and twenty-three units a week alcohol consumption are the vital cardiovascular risk factors.

The main focal point of this assignment will be discussing the epidemiology and pathophysiology of the Acute Coronary Syndrome, where the prevention, psychological issues and pharmacological management of the condition will be explored.

Case Study Background

As mentioned earlier, Mr Jim had a cardiac arrest in a football pitch where he was attended by a paramedic crew. Coronary heart syndrome is a condition range which includes "non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and unstable angina" (NICE, 2014). The scenarios are brought about by the sudden reduction of blood flow in heart. Sudden reduction of blood flow can be attributed to ruptured plaques in the coronary artery which eventually leads to the formation of a clot of blood. The bystanders at the football pitch gave Mr Jim Cardio Pulmonary Resuscitation (CPR) amounting to two rounds. In the treatment of the condition, it is advisable that the condition is known at an early stage so that immediate attention can be provided and solve the condition permanently. People from all around the globe should be taught the standards of performing a CPR, to give first aid to people undergoing cardiac arrest. The compelling evidence that has been provided in the United Kingdom is that only forty per cent of people with cardiac arrests survive (Hasselqvist-Ax, Riva, Herlitz, et al.,2015). The latter shows the fervent need for teaching cardiopulmonary resuscitation practices to all people in the nation.

Despite the compelling evidence provided in the previous section of the essay, several improvements have been developed. For instance, a defibrillator is being installed in regions where several people meeting is expected to be high. According to Gavin, a community which is co-ordinated and practical is key to improving survival of people facing cardiac arrests around the globe (2015). Defibrillators that are automated are relevant in increasing the survival chances of people facing cardiopulmonary diseases and could save lives annually (Circulation,2014).

Diagnosis of ACS

The most common diagnostic test for ACS is the use of 12 lead ECG. The patient was then taken to the catheterisation lab for further diagnosis and evaluation. The patient was found to have inferior STEMI using the ECG test. Inferior STEMI refers to the contraction and infraction of the myocardial walls of the heart. This condition occurs when the tissues of the myocardial walls are injured because of the formation of a blood clot in the heart vessel- particularly the right artery (Haelio, n.d.). Physicians prefer the 12 lead ECG diagnostic tool in ACS due to its ability to produce 3- dimensional images of the electrical activity function of the heart. The images are produced from twelve different viewpoints of the heart. According to the British heart foundation, the 12 lead ECG diagnostic test is done by using unipolar and bipolar leads (Heart Foundation, no date). In the ECG diagnostic technique, the important tool is the placement of the lead correctly; it is also crucial to take accurate recordings. The inaccurate placement of the lead electrode can significantly skew the diagnostic results (Walker, S. 2019).

The ECG diagnostic test results can differ significantly as a result of small changes in the placement deviation. According to McCann, even minute changes such as a deviation of between 20-25 mm from the right placement position could result in clinically significant changes (McCann et al. 2007). The adoption of automated interpretation of the diagnostic test of 12 lead ECG began in the early 1950s. The automated interpretations were a welcomed innovation in the diagnosis of ACS as it enabled physicians to reduce reading time and increase precision in interpreting normal ECGs in an accurate manner. Despite the automation of interpretations, physicians are prone to make errors in misinterpretations because of recording mistakes in lead reversal. According to Smulyan, precise automated interpretations are important in helping to save physicians time in areas where trained diagnostic test readers are unavailable (Smulyan, H. 2019). Alpert opines that "Optimism was so high in cases where automated ECG interpretations were accurate, precise and timely, the decisions and readings were quickly overturned and thus the advantages of the computerization were proved to be helpful" (Alpert, JS. 2012).

The other notable diagnostic test is the testing of blood for levels of cardiac troponin. Essentially, a troponin test diagnosis the level of T proteins present in the blood. The troponin proteins are the standard indicators of cardiac damage. The significance of cardiac damage is correlated with higher levels of troponin proteins in the blood. Low levels of troponin proteins in the blood could be an indication of unstable angina. In the case of Mr Jim, the results indicated high levels of troponin protein in the blood. The repetitive test result showed a high sensitivity of troponin, and this result indicates an increase in diagnostic accuracy.