It can be notedthat the acute pathophysiological condition that has led to Dean’s currentpresentation is, unstable angina that has also caused a right sided myocardialinfarction. To begin, unstableangina is categorized as an acute coronary syndrome, which means that it is acondition in which there is some form of blockage preventing blood to themyocardium (“Acute Coronary Syndrome” 1). It iscaused due to atherosclerosis, which is when the arteries begin to narrow andprevent the heart from receiving oxygen (Sullivan 1). The most common cause ofunstable angina is when atherosclerotic plaque in the coronary artery ruptures(“Unstable Angina” 1).
Theplaque has a fibrous cap made of epithelial cells, which, if destroyed can leadto exposure of cholesterol or calcium (Button 22). This causes platelets togather on the exposed plaque and arteries can become blocked if too manyplatelets accumulate together (Button 22). Ultimately, this creates a decreasedblood supply to the myocardial tissue and can cause infarct (Button 22).
Thismay also lead to necrosis if this issue is not addressed (Button 22). It is clearthat Dean is presenting with unstable angina due to several factors. Firstly,he has chest pain that radiates in his back and shoulders (“Unstable Angina”1). Dean is also overweight, over forty-five-years old and male which makes himmore at risk for this condition (“Unstable Angina” 1).
The reason that this isnot likely stable angina is due to the fact that his chest pain is existingwhile at rest and is lasting for a period of longer than twenty minutes (Sullivan1). Next, it can benoted that Dean has high cholesterol and high blood pressure based on themedication list provided. He takes Bisoprolol fumarate and Irbesartan-Hydrochlorothiazideto treat his hypertension (“Irbesartan-Hydrochlorothiazide” 1).
In addition,Dean takes Atorvastatin calcium to lower his cholesterol as a way to reduce hisrisk of cardiovascular disease (“Atorvastatin calcium” 1). Having high bloodpressure and high cholesterol also puts Dean at a higher risk for unstableangina (“Unstable Angina” 1). Following,due to the fact that Dean has a grey skin colour, it is evident that the rupturedplaque has led to an inadequate blood flow around the body (Baker 1). This lackof oxygen can also explain the mottling in his hands and legs (Baker 1). Deanis also profusely sweating, dizzy and has vomited. These are all symptoms of unstableangina (“Unstable Angina” 1).
Lastly in regards to unstable angina, the hearthrhythm presented on the monitor is called atrial fibrillation (Riedl 1). It iscommonly seen in patients with any type of angina as blood to the ventricle isimpeded. This is why Dean is presenting with this rhythm (Riedl 1). Thereason that it is likely that the unstable angina has led to a right sidedmyocardial infraction is seen based on his vital signs. Dean has a slow heartrate, that is also weak and irregular. The reason for a slow heart rate is dueto the fact that the sinoatrial node and the atrioventricular node in the rightatrium are compromised due to a blockage of the right coronary artery (Button39).
This blockage is also the reason for an absence in his peripheral pulsesas a full occlusion of the artery causes a decrease in distal blood flow(Button 39). Dean is also presenting with a low blood pressure which explainsthe low cardiac output (Button 39). Thirdly, there are no adventitious soundsheard in upon auscultation, which is also a clear sign that a right sidedmyocardial infarction has led to Dean’s current presentation (Singh 1).