Analyzing Chest Heaviness: A Case Study on Coronary Artery Disease

This case study analyzes Mr. Ferguson's chest heaviness, a symptom of coronary artery disease caused by blocked arteries and reduced blood circulation. It discusses the pathophysiology of chest heaviness, focusing on cholesterol buildup and plaque formation leading to myocardial infarction. The study explores the pharmacokinetics of glyceryl trinitrate, a medication used to alleviate chest heaviness by dilating blood vessels, while also addressing potential tolerance and side effects. Nursing management strategies are outlined, emphasizing the importance of assessing the condition's nature and magnitude using tools like the PQRST assessment. Furthermore, the study underscores the significance of patient education in managing chest heaviness through diet, medication adherence, and exercise. The conclusion highlights that patients can lead normal lives by understanding their condition and implementing proper management mechanisms, emphasizing the role of glyceryl trinitrate and lifestyle modifications in mitigating attacks.

Running head: FERGUSON CHEST HEAVINESS CASE
1
Ferguson Chest Heaviness Case
Student’s Name
University

FERGUSON CHEST HEAVINESS CASE
2
Ferguson Chest Heaviness Case
Introduction
Breathing challenges are an indicator that the patient is having chest heaviness due to blockage
of arteries which lead to reduced blood circulation thus forcing the heart to struggle with the
limited oxygen in the blood. Patients with such conditions need to learn how to manage the
condition in case the attack appears since in most cases, the patient is required to deal with the
situation immediately to increase the effectiveness of medication and reduce the effects of the
condition.
The pathophysiology of chest heaviness
Mr. Ferguson presents cheat heaviness which is a common symptom for coronary heart artery
disease that blocks arteries thus reducing circulation. The chest heaviness problem is a result of
shortness of breath making it impossible for the patient to breathe well. When cholesterol builds
up in the arteries, it leads to thickening of the walls which make the arterial space narrow thus
limiting blood flow (Tobin, 2010). The outcome is the reduced amount of blood that reaches the
heart muscles which means that the amount of oxygen that the heart receives too is low thus
damaging the endothelium. These effects lead to the accumulation of cholesterol, fats, and
lipoproteins in the artery vessels. Fatty acids are then formed in the artery which produces the
extracellular matrix that forms the atherosclerotic plaque that narrows the luminal space (Carlos,
2004). The outcome of all this is a narrow cap with an edge that leads to acute coronary disease.
As the plaque deposits grow larger, the blood vessel are narrowed leading to myocardial
infarction which is mostly known as heart attack. This occurs mostly when the heart fails to
function due to insufficient oxygen.

FERGUSON CHEST HEAVINESS CASE
3
Pharmacokinetics of the prescribed medications and their indications.
Baren, Brennan, & Brown (2008) suggests that Glyceryl trinate is a common medication for high
blood pressure and heart failure patients by reducing chest heaviness through increasing blood
circulation thus restoring the patient to normal conditions. As a nitrate family drug, it works by
dilating the blood vessels thus increasing blood circulation in the body which restores breathing
to normal thus making the heaviness to disappear. The role of the drug is to reduce heart attacks
that patients with the condition face by restoring the breathing thus reducing the risk of heart
failure in most patients. The drug works by producing nitric oxide which activates for guanlyl
cyclace that leads to the formation of cyclic guanosine monophosphate a compound that is
mostly used to produce nitrogen which makes the arteries and muscles relaxed thus increasing
blood circulation. The mechanism that the drug uses reduce chest heaviness is the fact that
Glyceryl is rapidly absorbed in buccal and sublingual mucosa when inhaled or taken through any
other means thus the effects of the drug can be realized within five minutes of taking. Patients
who do not react to the drug like Ferguson need to visit the nearest health facility or call a doctor
immediately.
For the drug to be effective Kaski, Arrebola-Moreno, & Dungu (2011) suggest that it has to be
taken within a short time after the attack starts so that the reverse mechanism of the drug can be
realized. In most cases, patients who have taken the drug immediately after they sense signs of
an attack have reported positive results. According to Albrecht (2013), the medication becomes
less effective as the patient uses it with time which may be one of the reasons why Ferguson has
not noticed any changes in the disease even after taking several puffs of the spray. The immune
system of the body develops tolerance making the effectiveness of the drug limited from three

FERGUSON CHEST HEAVINESS CASE
4
weeks of continuous use. Patients who have developed tolerance to the drug require a lot of
doses of the same for their bodies to respond to the symptoms of the disease. Other reported side
effects of the drug include vascular abnormalities that lead to the increased prognosis of the
disease leading to endothelial dysfunction. Some patients experience side effects like impaired
transformation, counteraction of GTN, plasma volume expansion and some people may feel
oxidative stress.
Nursing management of the adverse effects of the medication
According to Thull-Freedman (2010) chest pain or heaviness patients need to be diagnosed
according to specific guidelines established by the relevant body. This means that the practitioner
has to follow a set of measures and steps for establishing the condition that the patient is facing.
In the case of Ferguson, the first step that the practitioner needs to do is to determine the nature
of the condition that the patient is facing and its magnitude. Chest heaviness is not always an
indicator of a heart attack since it can sometimes arise from indigestion, innocuous problem or
even muscle strain as a result of anything like heavy exercise. Therefore, the practitioner needs
to carry out an assessment of the problem through the use of tools like the PQRST assessment
which seeks to determine the provoking factor of the problem, the quality of the heaviness and
the severity of the problem according to what the patient feels (Karnath, Holden, & Hussain,,
2008). The role of this is to allow the practitioner to assess the risks that the patient may be prone
to like the possibility of an imminent heart attack. If the practitioner notes at least two risks that
the patient presents according to the signs, then there is a possibility of a heart attack.
Information that the practitioner will share with the patient on managing the condition

FERGUSON CHEST HEAVINESS CASE
5
Manageable conditions like chest heaviness require practitioners to educate patients on how to
manage such conditions when the symptoms appear. Arnold, Goodacre, Bath, & Price (2009)
argue that chest heaviness can be fatal if the patient does not know how to manage the problem.
The role of nursing education is to empower patients with the ability to manage conditions when
attacks occur mostly at home. Since the easiest way to manage chest heaviness is the use of the
spray, then it means that nursing education should be used to ensure that the patient learns ways
of managing the condition when it occurs. Thus patients are required to have the ability to detect
early signs and symptoms of the condition so that measures can be taken to address the problem.
The first thing that the practitioner needs to assist the patient to understand is the fact that diets
with heavy fats are some of the major causes of blocked arteries. Therefore patient needs to be
taught how to maintain diets heavy with fresh vegetable and fruits and the same time limit intake
of processed foods, fried foods, greasy foods, and alcohol. Maintaining a diet low in fats reduces
the accumulation of cholesterol in the arteries which makes the condition more challenging to
manage.
One challenge that most patients who have conditions that require them to take medication every
day are managing their medications. The role of medications is to put the body in a way that
reduces the ability of episodes to occur. This means that the patient has to find a way of tracking
the medication and following the prescribed order to realize the efficiency of the drugs. In the
case of Ferguson, the practitioner can work with him to determine his routine and develop a way
of ensuring that the routine is intertwined with the medication (Berra, Fletcher, & Miller, 2007).
The patient needs to understand the triggers of the attack in his routine so that medications can
be taken in real time. The practitioner should work with the patient to develop a management

FERGUSON CHEST HEAVINESS CASE
6
plan that Ferguson can follow. For example, the patient needs to understand the importance of
walking with glyceryl everywhere so that attacks can be managed early when they occur. This
also includes ensuring that the patient understands the signs and symptoms of an attack so that
they can use the inhaler immediately. Since glyceryl works well if taken in the early moments of
the attack, then the patient needs to be assisted to personally manage the condition.
Exercise is another element that the practitioner needs to focus on by keeping the patient
physically fit and increasing blood circulation thus reducing the accumulation of fats. Simple
exercises like rising of a bicycle, brisk walking, jogging, and playing exercise that does not
require a lot of physical activity are good for such patients (Brown, Clark, Dalal, Welch, &
Taylor, 2011). Exercise leads to easy management of the condition since once the body is
physically fit, then it is difficult for one to encounter episodes of chest heaviness. In the case of
Ferguson, the type of exercise adopted should relate to his personal life routine so that it
becomes easy for him to exercise.
Conclusion
Patients with chest heaviness problem can lead a normal life if they understand the nature of their
problem and put proper mechanisms in place to manage the condition. This is a condition that
cannot be treated but drugs can be used to reduce the magnitude of the attack. Through
management education, practitioners ensure that patients adequately and properly use glyceryl as
a remedy for the attack episode. This means that the drug has to be taken immediately when the
episode occurs to increase the efficiency of the drug. Therefore, Ferguson needs to adequately
manage the condition by taking medication adequately, exercising, maintain a proper diet and

FERGUSON CHEST HEAVINESS CASE
7
knowing the signs and symptoms of the conditions when episodes start so that glyceryl can be
taken immediately.

FERGUSON CHEST HEAVINESS CASE
8
References
Albrecht, S. (2013). The Pathophysiology and Treatment of Stable Angina Pectoris.
Cardiovascular, 38(2), 43-60.
Arnold, J., Goodacre, S., Bath, P., & Price, J. (2009). Information sheets for patients with acute
chest pain: randomised controlled trial. BMJ, 338.
Baren, J., S.G., R., B. J., & Brown, L. (2008). Pediatric Emergency Medicine. Philadelphia:
Elsevier.
Berra, K., Fletcher, B., & Miller, N. H. (2007). Chronic stable angina: Addressing the needs of
patients through risk reduction, education and support. 5th Québec International
Symposium on Cardiopulmonary Prevention/Rehabilitation, (pp. 13-15). Québec .
Brown, J., Clark, A., Dalal, H., Welch, K., & Taylor, R. (2011). Patient education in the
management of coronary heart disease. London: Wiley.
Carlos, J. (2004). Pathophysiology and Management of Patients With Chest Pain and Normal
Coronary Arteriograms (Cardiac Syndrome X). Circulation, 109, 568-572.
Karnath, B., Holden, M., & H. N. (2008). Chest pain and its importance in patients with panic
disorder: an updated literature review. Primary Care Companion to the Journal of
Clinical Psychiatry, 105, 376-383.
Kaski, J., Arrebola-Moreno, A., & Dungu, J. (2011). Treatment strategies for chronic stable
angina. Expert Opin Pharmacother, 12, 2833-2844.
Thull-Freedman, J. (2010). Evaluation of chest pain in the pediatric patient. The Medical Clinics
of North America, 94(2), 327-347.

FERGUSON CHEST HEAVINESS CASE
9
Tobin, K. (2010). Stable Angina Pectoris: What Does the Current Clinical Evidence Tell Us?
The Journal of the American Osteopathic Association, 110(7), 364-370.