Angina is chest pain resulting from a variation between the heart muscles’ oxygen requirement and the myocardial blood flow. It is a probable symptom of an intrinsic heart condition (Knuut et al., 2020). From the history of E.H., it is likely that E.H. was already diagnosed with a heart condition since he was on calcium channel blockers and he has a remarkable history of drug abuse, specifically, cocaine.
To diagnose E.H. with angina I will measure the blood pressure, if it is high it will implicate hypertension and tachycardia, which are risks for angina. Tests needed for confirmation include an electrocardiogram test showing the heart’s electrical activity, and a coronary angiography that aids in identifying the heart and blood vessels. A blood test that detects increased cholesterol and leakage of some enzymes like creatinine kinase in the blood increases angina risk. For assurance of E.H.’s angina diagnosis, I would order all these lab tests and from the interpretation of the results, I would confirm the angina diagnosis. Cocaine effects induce hypertension and tachycardia, causing an increased oxygen requirement. E.H. has been addicted to cocaine for relatively some time, which increased his risk for angina.
The ultimate objective of treating E.H. is to mitigate the symptoms and delay the progression of angina into serious heart disease (Camero, 2017). In treating E.H. I will also aim to dismiss future eventualities such as myocardial infarction and early death. By treating E.H. I will not only treat angina but will also aim at improving the health of E.H., his quality of life, and life expectancy.
Dietary and lifestyle changes are vital aspects of angina management for the patient. Consumption of foods with high fat and cholesterol level should be stopped. Animal products, processed meat, and fries are the main types of high-fat and cholesterol-level foods. E.H. should have meals rich in fresh fruits and vegetables, meals with Omega-3 fatty acids, specifically fish. Low-fat proteins are recommendable for E.H. to improve his blood flow (Anderson et al., 2017).
Frequent exercises for at least thirty minutes a day will make improve the health of E.H. though they should be done moderately to avoid overwhelming the already affected heart. Tobacco smoking has detrimental effects on cardiovascular health, making it necessary for E.H. to cease smoking.
Excess weight increases muscular activity, affecting the myocardial muscles as they do not receive enough oxygen, increasing heart disease risk. Regular exercises will help E.H. in managing the body to have a healthy weight. Triglyceride levels in the blood increase plaque formation along the arteries; the patient should regulate alcohol consumption to avoid high blood triglycerides. Stress leads to a faster heartbeat, forcing the heart to beat vigorously, and this would cause angina. Thus, it is advised that E.H. seeks counseling to relieve stress.
The drug therapy for E.H. should include Beta-blockers, daily aspirin, nitrates, and calcium channel blockers. Aspirin is relatively cheaper, and it will have few adverse effects on the E.H. Beta-blockers decrease oxygen requirements hence reducing heart rate and risk for angina. Calcium channel blockers regulate the heartbeat relieving angina (Rousan et al., 2017). I will use recommended lab tests to monitor successful treatment and full recovery of E.H.
An electrocardiogram is observed to check on the heart rate. Computer tomography and coronary angiography, and blood tests are done regularly to monitor any elevating factors (Lanza, 2019). The drugs E.H. receives have different interactions; Simvastatin used in angina reacts with grapefruit juice, increasing the drug’s effect. The cardioprotective effects of aspirin are reduced by ibuprofen.
Beta-blockers at times cause arterial spasms causing the narrowing of the arteries; the tapering of the arteries increases the severity of angina. In the event the narrowing effect is observed on E.H., beta-blockers are withheld. Vasodilation effects of calcium channel blockers can lead to the withdrawal of the drugs. When the first-line angina medications fail, the second-line regime is started. The second-line drugs are Ranolazine, Ivabradine, and Nicorandil.
Patient education help informs E.H. about a lifestyle that facilitates healing. I will offer the following advice to E.H. to aid his recovery and treatment. E.H. should reduce intake of meals with high-fat content, cease smoking, avoid alcohol, and keep exercising to control body weight. Before a diagnosis is made and due medication regimes started or are resumed, E.H. can buy nonsteroidal anti-inflammatory drugs such as aspirin from the chemist to help him manage it.
References
Anderson, L., Brown, J. P., Clark, A. M., Dalal, H., Rossau, H. K. K., Bridges, C., & Taylor, R. S. (2017). Patient education in the management of coronary heart disease. Cochrane Database of Systematic Reviews,6-10.
Camero, Y. (2017). Management of Coronary Artery Disease and Chronic Stable Angina. US Pharm, 42(2), 27-31.
Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C.,… & Bax, J. J. (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal, 41(3), 407-477.
Lanza, G. A. (2019). Diagnostic approach to patients with stable angina and no obstructive coronary arteries. European Cardiology Review, 14(2), 97-102.
Rousan, T. A., Mathew, S. T., & Thadani, U. (2017). Drug therapy for stable angina pectoris. Drugs, 77(3), 265-284.