The client usually has central chest pressure when mowing the lawn that is relieved with rest and nitroglycerin. Today while sitting and reading the paper, he got pain that is now left sided, radiating down his arm, rated “4”. He took 3 nitroglycerin 5 minutes apart without relief. What is the understanding of this situation?
A.
The client now has developed a myocardial infarction
B.
The client has developed Prinzimetal’s angina.
C.
The client now has stable angina.
D.
The client now has unstable angina.
The Correct Answer and Explanation is:
The correct answer is A. The client now has developed a myocardial infarction.
Explanation:
Myocardial Infarction (MI), commonly known as a heart attack, occurs when blood flow to a part of the heart muscle is blocked for a long enough period that part of the heart muscle is damaged or dies. The scenario described suggests that the client’s chest pain has evolved significantly in both intensity and character compared to their usual angina.
- Change in Pain Characteristics: The client normally experiences central chest pressure that is relieved with rest and nitroglycerin, which is consistent with stable angina. However, today, the pain has shifted to the left side, radiating down the arm, which can be indicative of a more severe condition, such as an MI. Radiating pain and a change in pain location are common features of myocardial infarction.
- Pain Unresponsive to Nitroglycerin: The client took three doses of nitroglycerin five minutes apart without relief. In stable angina, pain typically resolves with rest and nitroglycerin. The fact that the pain does not improve with nitroglycerin suggests that the client may be experiencing a myocardial infarction rather than stable angina or Prinzmetal’s angina.
- Persistent Pain at Rest: The client’s pain occurred while sitting and reading, not during physical exertion. This is different from stable angina, which is usually triggered by physical activity or stress and relieved by rest. Pain at rest, especially if severe and persistent, is concerning for myocardial infarction.
- Duration and Intensity of Pain: The pain rated as “4” on a scale (assuming this is moderate) and unrelieved by nitroglycerin further supports the possibility of an MI. Stable angina would typically present with less severe pain and would improve with standard treatments.
Prinzmetal’s angina is characterized by episodes of chest pain due to coronary artery spasm, usually occurring at rest or at night, and may respond to nitroglycerin, which is not the case here. Unstable angina might fit the scenario where chest pain occurs at rest and is not relieved by nitroglycerin; however, the persistent pain and lack of response to medication strongly suggest a myocardial infarction rather than unstable angina.
Therefore, based on the symptom presentation and lack of response to typical angina treatment, the client is likely experiencing a myocardial infarction and should seek immediate medical attention.