The presented case involves a middle-aged man, E.H., who has a long history of asthma, presumed heart attacks, and cocaine use. This individual requires to prescribe him calcium channel blockers because he complains about the pain in the chest. It is critical to conduct a thorough analysis of the pain’s duration, causes, the localization, and what makes the pain better or worse. Unfortunately, the patient cannot identify those factors, which emphasizes the necessity of conducting specific tests and making a diagnosis. This paper aims to investigate this situation, outline the angina diagnosis process and further monitoring, and find the relationship between illness and drug abuse.
First, it is essential to list the goals of treatment. The primary objectives of angina treatment include alleviation of the symptoms, an increase in angina-free periods, improving life quality, and preventing cardiovascular events or death in the future (Ferrari et al., 2018). Consequently, it is critical to keep in mind all disease management goals to achieve the best outcomes for the selected individual. Proper treatment highlights the necessity of lifestyle modification and controlling potential risk factors to minimize angina’s influence on one’s living.
Thus, one should proceed with the steps to diagnose the illness. Common symptoms involve pain and discomfort in the chest, described as tightness, burning, or squeezing, shortness of breath, nausea, and weakness (National Heart, Lung, and Blood Institute, 2018). After looking through the personal health history, the patient must undergo diagnostic tests and procedures, starting with a physical examination, measuring blood pressure and heart rate, and taking temperature. Then, blood tests to identify cardiac troponins, specific proteins, cholesterol, and fats are required (National Heart, Lung, and Blood Institute, 2018). This way, it is possible to identify whether the patient is experiencing a heart attack or angina.
The next step would be conducting a chest X-ray and electrocardiogram (EKG). Those procedures can help check the possibility of a heart attack and search for lung disorders or other reasons for the pain (National Heart, Lung, and Blood Institute, 2018). Although an X-ray does not provide sufficient information to diagnose angina, it can exclude other causes. It is also possible to have echocardiogram and stress testing to assess heart functions (National Heart, Lung, and Blood Institute, 2018). The combination of the physical examination and diagnostic tests can generate a picture of the individual’s heart condition and diagnose angina or the risk of heart problems.
It is also vital to remember E.H.’s drug use history because it can have implications for the illness. Using cocaine for an extended period can result in “coronary endothelial dysfunction, which increases the sensitivity to catecholamines, causing epicardial and microvascular disease” (Kumar et al., 2018, p. 955). In such a way, one can state that the consumption of drugs can be related to the chest pain that the man experiences. Accounting for the personal history of cocaine use and the fact that the last time it happened around two weeks ago is obligatory while deciding on the treatment measures.
One of the most significant recommendations gives to the patient would be introducing new dietary and lifestyle habits. According to Massera, Graf, Barba, and Ostfeld (2016), sticking to a whole-food plant-based diet can terminate and improve coronary diseases and survival. Hence, the first thing that the selected patient should consider is changing his eating preferences, having a healthier and active lifestyle. Although it might be a challenge in his current family situation, because he lives with several children, it is necessary to recover and decrease the likelihood of adverse consequences.
The treatment process will utilize the medicines that can help control the instances of angina and alleviate pain. It is ineligible to prescribe beta-blockers, considering the recent cocaine use, because it can lead to the increased blood pressure due to unopposed alfa receptor stimulation (Richards, 2016). The patient’s initial request was to prescribe calcium channel blockers, and under the conditions that E.H. cannot take beta-blockers, the prescription of this drug is an alternative option in this case. Moreover, beta-blockers are not compatible with asthma disease, and the selected patient has it in his medical history (Wee, Burns, Bett, 2015). Thus, the man will receive drug therapy that involves calcium channel antagonists’ intake verapamil. It is critical to monitor the patient’s health condition through blood tests and physical examination to observe whether the proposed treatment is working.
Some of the significant aspects to remember are verapamil interactions with specific foods and the possibility of side effects. It is not recommended to use the prescribed drug with such medicines as betaxolol, alprenolol, lurasidone, and others (Mayo Clinic, 2020). Consequently, it is essential to ensure that the patient is not taking any of those drugs, which might require altering the dose or timing of the medicine intake. Besides, verapamil is not recommended to interact with ethanol and grapefruit juice because it can lead to an increased risk of side effects (Mayo Clinic, 2020). The medicine can cause various adverse effects, and precise monitoring is necessary. In case the patient is experiencing low blood pressure, blurred vision, or faintness, second-line therapy with diltiazem can be considered.
Based on the prescribed therapy, it is crucial to ensure that the patient is aware of the consequences of not following the recommendations. Moreover, E.H. should receive guidance and additional knowledge about the prescribed drugs and their possible implications. It is critical to emphasize the necessity of a proper diet and a healthy lifestyle. It is also possible to suggest to add dietary supplements such as L-carnitine, which can help to reduce angina symptoms (Massera et al., 2016). In conclusion, diagnosing, treating, and assessing the effect of angina is a thorough process that requires careful attention and the consideration of all details.
References
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Kumar, V., Gopalakrishnan, L., Singh, M., Singh, S., Kovacs, D. F., Benatar, D.,… & Khosla, S. (2018). Effect of cocaine on coronary microvasculature. Journal of the American College of Cardiology, 71(8), 954-955.
National Heart, Lung, and Blood Institute. (2018). Angina. Web.
Massera, D., Graf, L., Barba, S., & Ostfeld, R. (2016). Angina rapidly improved with a plant-based diet and returned after resuming a Western diet. Journal of Geriatric Cardiology, 13(4), 364-366.
Mayo Clinic. (2020). Verapamil (oral route). Web.
Richards, J. R. (2016). Beta-blocker management of cocaine-induced chest pain. Cardiology in Review, 24(6), 324.
Wee, Y., Burns, K., & Bett, N. (2015). Medical management of chronic stable angina. Australian Prescriber, 38(4), 131-136.