Case Study Analysis: Managing Angina in an Elderly Patient

This assignment presents a case study focusing on a 75-year-old man named Fred who is suffering from angina, a heart condition characterized by chest pain or discomfort due to reduced blood flow to the heart. The case study details Fred's lifestyle, including his retirement, smoking habits, alcohol consumption, and dietary choices, which contribute to his diagnosis. The assignment explores the different types of angina, its symptoms, and underlying causes, including coronary artery disease and risk factors such as unhealthy cholesterol levels and smoking. Furthermore, the assignment outlines the medical interventions used in treating angina, such as electrocardiograms, stress tests, and blood tests, along with medications like aspirin, nitrates, and beta-blockers. The study emphasizes the importance of lifestyle changes, including quitting smoking, eating a healthy diet, and managing stress, for effective angina management and preventing further cardiovascular complications. The case study underscores the significance of self-care management and the role of general practitioners in guiding patients toward healthier lifestyles and medical interventions.

Understanding
Physical Conditions

INTRODUCTION...........................................................................................................................1
Understanding of Angina............................................................................................................1
Medical interventions used in treatment of Angina....................................................................4
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Development of individual health is really indispensable for enjoying better physical
health conditions and succeeded in minimizing negative affect of dangerous disease. In fact,
every person wanted to live healthy life by taking necessary initiatives in their life. For example;
regular exercise, taking precautions from unhygienic food, follow proper routine from morning
till night and do various things for being a healthy person (Losordo and et. Al., 2011). Thus,
main objective of this assignment is to highlight the case study of a person who is suffering from
heart problem that is; Angina. Moreover, an effective recommendation is going to outlined in
this project by General Practitioner of a patient for self-care management. Apart from this,
suitable medical intervention for treating Angina is also framed at the end of project.
Understanding of Angina
In the given case study, a person who is 75 year old named as Fred is living in a privately
owned bungalow after getting retired from railway job. Thus, for enjoying his day to day life,
Fred went for pub three times in one week and meet with his friends. Basically, he loves to have
food and believe in enjoying the moment of life by completing all his wishes. As a result, he gets
affected by disease named as Angina which is a kind of heart problem.
Angina- This is not a disease but it’s just a sign of coronary artery problem in which
person face normal hear issues such as; tightness, pain or discomfort in their chest. However,
major reason behind occurrence of this problem is due to improper passing or minimum blood
oxygen in chest. Basically, pain of angina means that, some of the muscles associated with heart
is not able acquire enough blood which specifically occurred during exercise when heart is
working very harder. Sometime people get confused about the actual problem which occurred
due to angina such as; few think that it is a stroke but angina is a state where there is a permanent
damage of heart muscle (Jespersen and et. Al., 2011). Mainly, if an individual is suffering from
Angina then this will consider as one of the major indicator of heart problem. In fact, there are
various types of Angina is available which is described as follows-
 Stable or chronic Angina- In this problem, heart of normal human being work more
harder as compared to normal one such as; it happens during exercise. Mainly, this is
having a regular pattern that can be predicted for happening in months or sometime in a
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year. Hence, person requisite to do proper rest or take medication relieves for controlling
this situation.
 Unstable angina- This problem to a person incurred while doing rest and consider as
more serious because rest or medication get failed in resolving this instability. However,
this version is also seen as a signal of future heart attack in a minimum time period might
be hours or weeks.
 Variant and micro vascular angina- This type of angina is very rare and incurred
during rest period without any underlying coronary artery disease. Main reason behind
occurrence of this problem is because of abnormal narrowing or relaxation of blood
vessels of human beings as well as reduces flow of blood in a heart. Therefore, medicine
is only solution for getting free from this issue (Kikuchi and et. Al., 2010).
Hence, it has been understood that angina is having various types from which every
problem is having distinct reason behind occurrence but somehow symptoms of Angina is almost
same. Therefore, some of the most under-stable symptom of this disease is described below-
 Squeezing
 Pressure
 Heaviness
 Tightening
 Burning or paining across the chest which mainly begins behind the breastbone.
Meanwhile, pain in this disease spreads from neck, jaw, arms, shoulders, back or even
teeth of a person. Apart from above signs, some of patients also face few other which includes-
 Indigestion problem.
 Burning of heart
 Weakness in entire body.
 Sweating
 Nausea
 Cramping of muscles
 Shortness of breath.
It means, small angina can create major problem for normal human being which may
convert into serious heart issue that automatically affects the life of a person. In fact, an
individual face problem while doing their day to day job as well as feel very much low which act
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as an obstacle in healthy well-being of a normal person. Therefore, it is essential to take
corrective decision for controlling dangerous disease as well as needs to change regular routine
for managing this health issue. However, it’s not a life threatening but somehow it’s an initial
process and also consider as warning sign which shows that person is at a risk of a heart attack or
major stroke. Angina stay for almost 30 minutes which mainly doesn’t relived from taking rest or
medicine. Additionally, might get worse in coming time period and shows that heart attack or
stroke might incurred very soon (Hoenig, Aroney and Scott, 2010).
Major causes of Angina- This is an outcome of underlying coronary artery disease.
However, main objective of coronary arteries is to supply oxygen rich blood to the heart. At the
time of cholesterol aggregates on artery wall and hard plaques form the artery narrows
(Greenhalgh and et. Al., 2010). It means-
 Due to narrowing of arteries, reaching of oxygen-rich blood becomes very difficult
towards heart muscle.
 Damaging of arteries because of various factors such as smoking and increased levels of
fat or sugar in blood creates plaques which build up where arteries of heart get damaged.
 Moreover, plaques are the major reason for narrowing the arteries or may break off as
well as form a clotting of blood which resulted in blockage of arteries.
Consequently, it has been understood that actual angina attacks are the outcomes of reducing
supply of oxygen in the heart. Some of the common triggers of this issue covers distinct elements
such as; -
 Physical exertion
 Major emotional stress or tension.
 Heavy meal or having foods.
 Exposure to extreme temperatures.
 Smoking is one of the major reason behind angina attacks.
It means, distinct reasons are there due to which various types of angina attacks the body
of human being. For example; unstable angina is caused because of blood clotting which resulted
in partially or completely blockage of an artery. Although, larger clots is resultant into serious
heart attacks because clots are forming, dissolving and then forming again which makes angina
in every blockage (Goldstein and Chawla, 2010). On contrary to this, variant angina incurred
when artery experiencing a spasm which causes the tightening and narrowing as well as
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disrupting the supply of blood in heart. Basically, this will caused due to exposure of cold, stress,
medicines, smoking and usage of cocaine. Additionally, members who are in a risk of coronary
arteries and also risk of angina that also increase because there are interlinked with each other.
Some of the major risk factors includes-
 Unhealthy levels of cholesterol
 High blood pressure
 Smoking of tobacco.
 Diabetes
 Oversized or being an overweight person.
 Sedentary lifestyle.
 Family history on heart disease.
Medical interventions used in treatment of Angina
According to given case study of Fred is a person who gets affected by Angina problem
who is 75 year old men and retired from all his professional duties but her wife is still working
for a part time in a local supermarket for enjoying social contact. Because of retirement, Fred is
enjoying his life on his pension such as; smoker from last 30 years which is still continue, still
having glass of whisky in every night as well as trip to pub three times in a single week. Along
with this, he loves to eat due to which his weight is increasing on regular basis. As a result, he
gets affected or diagnosed with cardio-vascular disease due to that there is a symptom of angina
also. Hence, for controlling the risk of heart problem, Mary and Fred needs to change their day to
day routine for taking proper care by managing things in better manner. In fact, self-care
management automatically helps an individual for getting rid from major health problems.
Moreover, proper management also supports them in long term benefits as it helps in reducing
probabilities of emerging other health disease also. Although, Fred and Mary are aged people
due to which attack of disease are normal but still various specialist states that proper
management helps in controlling the danger. Along with this, it aids in increasing the healthy life
of senior citizens also by following healthy routine (Marinescu and et. Al., 2015).
An appropriate diagnosis is very much indispensable for preventing the patient from
heavy attacks and control angina. Initially, procedure begins with a physical exam and by
discussing symptoms, risk elements and medical history of family. General practitioner or
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physician who knows about the angina ordered some of the major tests that is detailed as
follows-
 Electrocardiogram (EKG)- Helps in recording electrical activity of heart and aids in
detecting heart when it is starved of oxygen.
 Stress test – Readings of blood pressure and EKG at that time when a patient is
maximizing his physical activity.
 Chest X-ray- This test helps doctor to analyse the structures within the chest.
 Coronary angiography- Dye and some unique x-rays which are used for highlighting
within the coronary arteries.
 Blood tests- It helps in analysing fat, cholesterol level of a person, sugar and various
protein levels.
 Nuclear stress test- By doing this, doctor comes to know about the measure of blood
flow in your heart during rest or while stress time period. However, it is same as routine
test but in nuclear test, a radioactive substance is going to injected into your
bloodstream (Bowling, Reeves and Rowe, 2012).
 Coronary angiography- By using X-ray examination within the heart blood vessels
will be done. It’s a section of general group of process consider as cardiac
catheterization.
 CT scan- In this procedure, a person will be lie on table within a doughnut shaped
machine. X-ray tube which is attached within the machine will rotates around the body
and acquire images of heart and chest as well which aids in showing narrowing of heart
arteries and enlargement of heart.
By doing all these tests, doctor prescribe some of the necessary medicines which is used
for improving the cardio-vascular or angina problem. For example; aspirin which helps in
reducing the ability of blood to make clot as well as aids in making easier for blood to flow
throughout the heart arteries. Secondly; nitrates that supports in widening of blood vessels and
allowed maximum blood to flow around the heart muscle. Thirdly, beta blockers use for blocking
the effects of hormone epinephrine which is consider as adrenaline. Statins used for lowering the
blood cholesterol. Apart from all these medicines there are few other prescriptions are also
present which are used by doctor for controlling the probabilities of heart problems (Diercks and
et. Al., 2010).
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On the other hand, Fred is enjoying very unhealthy life due to which he gets affected by
this problem. Instead of all this, Fred angina can also defend by changing him normal lifestyle to
healthier one as well as by treating with related conditions that may be exacerbate. Along with
this, delaying angina occurs by eating healthfully, quit smoking, he needs to be more physically
active and requisite for him to get aware about the way of handling stress (Henry, Satran and
Jolicoeur, 2014). Therefore, he needs to change his lifestyle and way of living for getting rid
from major heart problems or stroke. Some of the change which is requisite in Fred lifestyle is
discussed as follows-
 He needs to stop smoking as well as requisite to avoid exposure towards second-hand
smoke.
 He became overweight because of too many foods which are unhealthy in nature which
automatically cause heart issue. Therefore, he has to control his weight by eating
healthy diet and requires contacting his general practitioner for knowing about the
technique of losing weight.
 He needs to have only healthy foods which are having limited amounts of saturated fat,
lots of whole grains as well as prefer fruits and vegetables.
 Involved with doctor in a healthy conversation and learn about the technique of starting
a safe exercise.
 Exertion is also one of the major reasons behind angina, due to which Fred and Mary
needs to make sure that they take rest breaks for controlling the probabilities of heart
problem.
 If there is any other disease due to which there might be a chance of incurring angina
then treat the prior problem first. For example; if there is a symptom of diabetes in Fred
then he needs to control this first.
 Avoid taking stress but if you are getting failed in doing so than identify other ways of
relaxation such as; Fred is now retired then he have the opportunity of reading books,
gardening is another best medicine for minimizing stress and various other natural
activities (Andrell and et. Al., 2010).
 Fred must have to minimize his consumption of whisky which is really not good for his
health.
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 Contacting with friends is not bad but still he has to control it by three times in week to
only one time because it creates exertion which is not good for his health.
 Laughter is a best therapy for any disease. It means by avoiding going in pub he needs
to join a laughter groups for reducing stress level.
Additionally, Fred have to design suitable or proper routine for his regular life in order to
follow each or every steps in suitable manner. As this will help him in attaining long term target
also as well as get succeeded in living more happy life. Thus, daily routine which is requisite for
Fred is discussed as follows-
Timing Activity
6:00-6:30 AM Wake up and fresh-n-up
6:30-7:30 AM Morning walk
7:30-8:00 AM Relaxation time and just for feeling the morning
8:00-9:00 AM Breakfast but healthy or light food
9:00- 10:00 AM Take rest
10:00-11:00 AM Give some time to gardening and feel the beauty of environment by getting
surrounded with plants.
11:00-12:00 AM Have some fruits and enjoy some movies or any laughing programmes.
12:00-1:00 PM Read books or do whatever you want to do for relaxing yourself.
1:00-2:00PM Have your healthy lunch which is free from oil and fat materials.
2:00-4:00 PM Take rest and sleep
4:00-5:00 PM Enjoy the evening by having tea break in your balcony.
5:00-6:00 PM Meet with friends in park and have some healthy conversation
6:00-7:00 PM Relax at home
7:00-9:00 PM Watch TV or any other activity you want to do for entertainment
9:00-10:00 PM Have your dinner
After 10:00 PM Go to sleep for another fresh and healthy day.
This above routine will help Fred in removing angina problem and help in living a
healthy or disease free life. Along with this, this will help for long term as provide stress free
life.
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CONCLUSION
From the above report, it has been concluded that development or caring of health is
really indispensable in order to live a disease free life. This will happen only if a person will
follow an appropriate routine or have healthy diet. Therefore, whole project is focussing the
method of control heart problem or stroke which is affected by one aged person. Throughout the
analysis, it has been understood that proper care and management is very much essential for live
a healthy and successful life.
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REFERENCES
Books and Journals
Losordo, D.W and et. Al., 2011. Intramyocardial, autologous CD34+ cell therapy for refractory
angina. Circulation research, 109(4), pp.428-436.
Jespersen, L and et. Al., 2011. Stable angina pectoris with no obstructive coronary artery disease
is associated with increased risks of major adverse cardiovascular events. European heart
journal, 33(6), pp.734-744.
Kikuchi, Y and et. Al., 2010. Double-blind and placebo-controlled study of the effectiveness and
safety of extracorporeal cardiac shock wave therapy for severe angina
pectoris. Circulation journal, 74(3), pp.589-591.
Hoenig, M.R., Aroney, C.N. and Scott, I.A., 2010. Early invasive versus conservative strategies
for unstable angina and non‐ST elevation myocardial infarction in the stent era. Cochrane
Database of Systematic Reviews, (3).
Greenhalgh, J and et. Al., 2010. Drug‐eluting stents versus bare metal stents for angina or acute
coronary syndromes. Cochrane Database of Systematic Reviews, (5).
Goldstein, S.L. and Chawla, L.S., 2010. Renal angina. Clinical Journal of The American Society
of Nephrology, pp.CJN-07201009.
Marinescu, M.A and et. Al., 2015. Coronary microvascular dysfunction, microvascular angina,
and treatment strategies. JACC: Cardiovascular Imaging, 8(2), pp.210-220.
Bowling, A., Reeves, B.C. and Rowe, G., 2012. Do treatment preferences for patients with
angina change? An 18‐month follow‐up study. Health expectations, 15(4), pp.351-359.
Diercks, D.B and et. Al., 2010. Gender differences in time to presentation for myocardial
infarction before and after a national women's cardiovascular awareness campaign: A
temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients
Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National
Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes
Network–Get with the Guidelines (NCDR ACTION Registry–GWTG). American heart
journal, 160(1), pp.80-87.
Henry, T.D., Satran, D. and Jolicoeur, E.M., 2014. Treatment of refractory angina in patients not
suitable for revascularization. Nature Reviews Cardiology, 11(2), p.78.
Andrell, P and et. Al., 2010. Long-term effects of spinal cord stimulation on angina symptoms
and quality of life in patients with refractory angina pectoris—results from the European
Angina Registry Link Study (EARL). Heart, pp.hrt-2009.
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