A 40-Year-Old Male Patient with PMH Of CAD
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Q-2
A 40-year-old male patient with PMH of CAD, MI with a cardiac stent, chronic angina, chronic smoker admitted for pain on his right leg and for consideration for peripheral vascular surgery (PVS) on his right leg for peripheral arterial disease (PAD). The clinical characteristic of his condition is now probably an extension of his vascular disease to his periphery or diffuse vascular disease. Peripheral vascular disease is primarily driven by the progression of atherosclerotic disease leading to macro and microvascular dysfunction which typically affects lower extremity vascular beds. Larger arteries such as the abdominal aorta and iliac arteries are frequently involved, and more severe forms involve multivessel or diffuse disease. A detailed health his toey including lifestyles such as smoking, exercise, diet, intake of coffee or soft drinks, use of illicit drugs and alcohol, current medications, recent hospitalizations, and a thorough physical examination and diagnostic tests were needed and ordered. Considering his cardiac history is a major concern for surgery until unless his condition and tests results prove that he is cleared for surgery. Peripheral vascular surgery patients’ have an increased risk of postoperative myocardial infarction and/or death due to unrecognized coronary ischemia around 65 percentage (Krievins et al, 2019).
I would be doing a baseline CBC to evaluate the patient for anemia, infection or inflammation and platelet abnormalities and a BMP to evaluate any electrolyte imbalances, diabetes, and renal impairments, Lipid panel to evaluate for hyperlipidemia, Urine analysis to see any albuminuria due to hypertension, a baseline EKG to evaluate the presence of any new ischemia. An echocardiogram to evaluate the pressures in the chamber, any valvular and structural changes due to hypertension and MI, and his ejection fraction for any impaired pumping action. Since this patient has chronic angina with a history of MI with stents, I would also consult a cardiology opinion to evaluate whether he needs his angiography to visualize his coronaries. An EKG stress test is indicated for all noncardiac pre-op surgery patients for better prognostic value along with complimentary cardiac exams (Marcadet, 2019). An ultrasound Doppler study of both lower extremities and a CT angiography or an MRA will rule out the extend of occlusion on the affected leg. Since the patient is actively smoking, he needs a chest x-ray to evaluate any hyperinflation, COPD, pulmonary hypertension, or even lung cancers. Hence, I would also order complementarity tests such as PFT to evaluate his lung function. Measurement of the ankle-brachial index (ABI) is a cost-effective non-invasive objective measure for PAD diagnosis (Gul, & Janzer, 2021). A pre-op coronary computed tomography-derived fractional flow reserve (FFRCT) can help guide a multidisciplinary team approach to reduce postoperative cardiac events in PVS patients’ (Krievins et al, 2019). Assessment of PAD risk score with risk facto0rs such as smoking diabetes, hypertension, hypercholesteremia, and obesity (Gul, & Janzer, 2021).Reference.
Krievins, D., Zellans, E., Erglis, A., Zvaigzne, L., Kumsars, I., Latkovskis, G., … & Zarins, C. (2019). TCT-332 Pre-Op Diagnosis of Silent Coronary Ischemia Using CT-Derived Fractional Flow Reserve May Reduce Post-Op MI and Death in Patients Undergoing Peripheral Vascular Surgery. Journal of the American College of Cardiology, 74(13S), B330-B330. Retrieved from https://www.jacc.org/doi/full/10.1016/j.jacc.2019.08.413
Marcadet, D. M. (2019). Exercise testing: New guidelines. Presse medicale (Paris, France: 1983), 48(12), 1387-1392. Retrieved from
https://europepmc.org/article/med/31679896
Gul, F., & Janzer, S. F. (2021). Peripheral vascular disease. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK557482/
RUBRIC
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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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