After some rest, R.K.'s chest pain has subsided, and she tells you she feels much better now. You review her laboratory results
Laboratory Results
12-lead ECG: Light left-axis deviation, normal sinus rhythm with no ventricular ectopy
Serial CPK tests are 30 units/L at admission, 32 units/L 4 hours after admission
Cardiac troponin T is less than 0.01 ng/mL (at admission) and same result 4 hours after admission
Cardiac troponin T is less than 0.03 ng/mL (at admission) and same result 4 hours after admission
D-dimer test result less than 250 ng/mL
On the basis of the information presented so far, do you believe she had an MI? What is your
rationale?
Do you think she may have a pulmonary embolus?
While you care for R.K., you carefully observe her. Identify two possible complications of
coronary artery disease (CAD) and the signs and symptoms associated with each.
R.K. rings her call bell. When you arrive, she has her hand placed over her heart and tells
you she is "having that heavy feeling again." She is not diaphoretic or nauseated, but states
she is short of breath. What else do you assess, and what can you do to make her more
comfortable?
No. Her cardiac symptoms are probably a result of angina secondary to coronary artery disease
(CAD) rather than an MI, based on the following:
• Cardiac enzymes are within the normal range (for a female patient, 30 to 235 units/L). In the
presence of myocardial damage, CK-MB levels would rise 3 to 6 hours after infarction occurs and
would peak at 12 to 24 hours (if no further infarction occurs), then return to normal 12 to 48 hours
after infarction. CK-MB levels are not usually elevated with angina. Cardiac troponins typically
become elevated within 2 to 3 hours after an MI.
• The ECG did not show ST, T wave, or Q wave changes.
• Decreased activity and change of position somewhat relieved pain.
The D-dimer test results rule out the occurrence of a pulmonary embolus.
• Cardiac ischemia
• Cardiac dysrhythmias, particularly premature ventricular contractions: dysrhythmias seen on
telemetry, syncope, lightheadedness, shortness of breath, palpitations felt by patient
• HF: crackles; dyspnea; confusion; dry, hacking, nonproductive cough; peripheral edema; JVD
• Assess her VS, including pulse oximetry, and cardiac rhythm on telemetry.
• Order a STAT ECG.
• Give her supplemental oxygen as ordered (2 to 4 L/min. by nasal cannula) if she is not wearing it.
• Give her sublingual NTG 0.4 mg as ordered (1 q5min prn chest pain × 3 doses) to decrease the
venous return to the heart and dilate the coronary arteries to increase the O2 supply to the heart.
• Obtain an order for 30 mL aluminum hydroxide/magnesium hydroxide (such as Maalox) to rule out
GERD.
• Have her rest quietly in bed to decrease O2 demand.
• Elevate the head of the bed to facilitate respiratory expansion.
• Encourage verbalization of concerns to decrease anxiety and O2 demand.
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