history of stable angina and hypertension

John is a 76-year-old man with a long history of stable angina and hypertension. He is prescribed nitroglycerin tablets as needed for chest pain and lisinopril for his hypertension. John has noticed that his chest pain is occurring with increasing frequency and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets.

John is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and the left arm. He experienced some nausea and became diaphoretic and pale. Upon admission to the local emergency department, he was noted to have significant ST-segment elevation on a 12-lead electrocardiogram (ECG).

Discussion Questions:

1. What diagnosis is consistent with John’s history and physical exam?

2. Please differentiate between a STEMI and Non-STEMI.

3. What are the pathophysiological findings specifying an MI?

4.What are the differences between angina, silent ischemia, and myocardial ischemia?

5.Provide a description of the three factors associated with Sudden Cardiac Death.

6.What are the possible complications post-MI might the NP be aware of when caring for John?

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