Case Study 3 A 46-year-old man is
Case Study 3 A 46-year-old man is playing intramural basketball when he suddenly collapses on the court. Bystander CPR is begun; the patient is revived immediately without need for cardioversion or defibrillation. He regains consciousness before EMS arrives and, although he does not recall collapsing, he is able to tell them that he has been experiencing chest discomfort all morning (but didn’t mention it to anyone). The patient is transported in stable condition to the emergency department (ED) via ambulance. The total time from his collapse to hospital arrival is 77 minutes, due to the rural location of the high school where he was playing. When you see the patient in the ED, you learn that he has no prior history of cardiac symptoms. He specifically denies chest pain, shortness of breath, dyspnea on exertion, or peripheral edema, although with additional questioning, he admits to having ongoing substernal pressure. There is no history of hypertension, diabetes, or thyroid disorder. He does have high cholesterol but does not take his medication as prescribed. Surgical history is remarkable for a left anterior cruciate repair that he underwent while in high school. He is employed as an assistant principal at a local high school, is married with two children, and is active in his community—a fact borne out by the volume of well-wishers in the waiting area, inquiring about his status. He does not smoke, drinks two or three beers on the weekend, and does not use recreational drugs, although he admits he tried marijuana in college and didn’t care for it. He is not taking any routine prescription or holistic medications and has no known drug allergies. He reports taking ibuprofen on occasion but adds that he hasn’t taken any in the past three weeks. He was prescribed a statin about 1 year ago, but does not take it regularly. Review of systems is remarkable for a recent cold. He says he has a residual cough and runny nose but does not feel like he’s currently sick. He considers himself to be very healthy and a role model for the students and faculty at his school. Physical exam reveals a blood pressure of 142/84 mm Hg; pulse, 84 beats/min; respiratory rate, 18 breaths/min; and O2 saturation, 99% on 2 L of oxygen. His weight is 189 lb and his height, 74 in. He appears anxious and apprehensive but is alert and cooperative. Pertinent physical findings include a regular rate and rhythm, clear lungs, a soft, nontender abdomen, and no peripheral edema or jugular venous distention. The neurologic exam is intact. Specimens are drawn and sent to the lab for processing. While awaiting the results, you review the ECG taken at the time of arrival. Image transcription text AVR AVL VS VF V6 1. What is your interpretation of this ECG? 2. What is the treatment plan for your diagnosis (pharmacology, cardiac interventions and non-pharm)? 3. If you were to see this patient in your outpatient primary care clinic for follow-up, what patient teaching would be needed? 4. Given his diagnosis, should the patient be started on low, moderate or high dose statin? 5. Utilize current treatment guidelines to support your statin choice and document rationale for the statin choice.
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