Case Study: John Smith Answer

Patient Information

The following presentation aims to discuss the case study of:

• Name: Mr. Roger Smith
• Age: 58 years
• Gender: Male
• MHx: Hypertension, Dyslipidemia
• Fx: Father expired due to coronary artery disease
• SHx: Previous stent for anterior-lateral MI, Troponin T: 2700ng/l
• Investigation: ECG-ST segment elevation

Based on the above information, the case study is further evaluated using

Levett Jones clinical reasoning cycle (Gummesson et al., 2018).

Analysis- Step 1: Considering the situation of the patient

• Severe chest pain
• Crushing pain radiating to jaw and left arm
• Medical history of dyslipidemia and hypertension
• Elevated troponin T levels
• ST-segment elevation

Step 2: Collection of information/cues

• Presenting symptoms
• Duration of chest pain
• Nature of chest pain
• Results of ECG
• Medical, surgical and family history

Step 3: Processing the Information

• Acute Coronary syndrome
• Antero-lateral myocardial infarction
• Myocardial damage due to elevated levels of Troponin T and ST segment (Vogel et al., 2019)

Step 4: Identifying Issues/ Problems

• Myocardial infarction
• Neglect towards instances of chest pain in the past
• Delayed diagnosis and treatment

Step 5: Goal Establishment

• Stabilizing Mr. Smith’s condition
• Relieving his pain
• Management of dyslipidemia and hypertension
• Lifestyle modifications

Step 6: Taking action

• Medication administration: Aspirin, morphine and nitroglycerin
• Clopidogrel for prevention of clot formation
• Coronary angiography (Yin et al., 2023)
• Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (Kuno et al., 2020)

Step 7: Outcome Evaluation

• Chest pain
• ECG report
• Troponin T levels
• Vital signs (Sakamoto et al., 2018)

Step 8: Reflection and Learning

• Areas for improvement
• Recognition and prompt action on symptoms
• Patient education
• Management of co-morbidities (Miller et al., 2020)

Conclusion

• The major issues in Mr. Smith’s case were his severe condition antero lateral myocardial infarction coupled with his habit of neglecting previous episodes of chest pain and discomfort.
• The case was analysed using the eight steps involved in the Levett Jones clinical reasoning cycle which gave a comprehensive and systematic understanding.
• It is recommended to educate Mr Smith and his family regarding the severity and the management of his condition.
• Identification of symptoms and warning signs along with modifications in lifestyle is crucial for better health and well being of Mr. Smith.

References

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: A literature review and a case study. Physical Therapy Reviews, 23(1), 29-34. https://doi.org/10.1080/10833196.2018.1450327

Kuno, T., Ueyama, H., Rao, S. V., Cohen, M. G., Tamis-Holland, J. E., Thompson, C., & Bangalore, S. (2020). Percutaneous coronary intervention or coronary artery bypass graft surgery for left main coronary artery disease: A meta-analysis of randomized trials. American Heart Journal, 227, 9-10. https://doi.org/10.1016/j.ahj.2020.06.001

Miller, J., MacDermid, J. C., Walton, D. M., & Richardson, J. (2020). Chronic pain self-management support with pain science education and exercise (COMMENCE) for people with chronic pain and multiple comorbidities: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 101(5), 750-761. https://doi.org/10.1016/j.apmr.2019.12.016

Sakamoto, J. T., Liu, N., Koh, Z. X., Guo, D., Heldeweg, M. L. A., Ng, J. C. J., & Ong, M. E. H. (2018). Integrating heart rate variability, vital signs, electrocardiogram. The American Journal of Emergency Medicine, 36(2), 185-192. https://doi.org/10.1016/j.ajem.2017.07.054

Vogel, B., Claessen, B. E., Arnold, S. V., Chan, D., Cohen, D. J., Giannitsis, E., & Mehran, R. (2019). ST-segment elevation myocardial infarction. Nature Reviews Disease Primers, 5(1), 39.  https://doi.org/10.1038/s41572-019-0090-3

Yin, M. Q., Fan, L. H., & Chen, Y. H. (2023). Typical clinical presentation of acute myocardial infarction and confusing coronary angiography: A case report and literature review of coronary embolism. Medicine, 102(19). https://doi.org/ 10.1097/MD.0000000000033782        

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