Coronary Artery Disease & Cardiac Stent Placement
Patient presentation:
J.A., a 65 year-old female, presented with shortness of breath and fatigue while at work. She attempted to work through blaming tiredness for the symptoms. Finally co-workers encouraged her to go the ER because of her history. She had a history of stroke 10 years ago and is currently on Coumadin® at home. While in the ER she noticed chest tightness but felt as if it was brought on by her shortness of breath. After triage, while waiting to be seen the tightness in her chest continued to escalate to where medication was warranted for pain relief. She was also tachycardic.
Actions Taken:
The patient was placed on 2L of oxygen via nasal cannula, lab work for a CBC including PTT, INR, D-dimer, were sent in addition to cardiac enzymes. Cardiac enzymes were slightly elevated. The other results came back normal considering the alteration in the clotting times due to Coumadin® therapy. An ECG was performed and showed an elevation in the ST segment. Pt was admitted to the ICU on a 12 mcg/min of nitroglycerin IV for pain control.
Five hours later she underwent coronary angiography. The test showed an occlusion of the right coronary artery and she was therefore scheduled for a cardiac catheterization. During the procedure it was found that the patient had a 98% occlusion of the right coronary artery. This was a sclerotic plaque unlike the anticipated thrombus. Upon detailed review of history it was found that the patient had undiagnosed CAD. To remedy the occlusion, a permanent stent was placed in the coronary artery via the right femoral artery. Post procedure 3 mg of morphine was given every six hours as needed.
Outcome:
The next day the patient was sent home on bed rest. Her previous medications were continued and she was scheduled for follow-up with a cardiologist at the end of the week. Additionally she was prescribed Lipitor® 10 mg daily. She continued to work after recovery and has had no other noted problems with artery occlusion.