Clinical Electrophysiology Discussion Paper

Discussion 6.1

Mr. Skemp is a 76-year-old Asian American male with a complex medical background. He is currently experiencing chest discomfort after a cardiac catheterization procedure that ruled out angina. As such, a comprehensive patient-centered treatment strategy is crucial for an individual with a medical history that includes four coronary stents, GERD, atrial fibrillation, and a pacemaker (Heijman et al., 2018). To begin with, I would first conduct a thorough evaluation taking into account the recent catheterization findings, history of stents, and examination of any non-cardiac factors due to his GERD. I would further conduct an exhaustive examination of his drug regimen, specifically the need for dual antiplatelet treatment with Plavix and aspirin. Seeking advice from a cardiologist is also essential towards making proper modifications of the available medications (Sarairah et al., 2020). I would also recommend cardiac rehabilitation programs to the patient to enhance cardiovascular health, along with lifestyle adjustments that include a heart-healthy diet, weight control, quitting smoking, and employing stress-management techniques. Additionally, I would address treatment of GERD with Protonix through recommending the implementation of dietary and posture-related adjustments. Finally, I would schedule follow-up appointments for the patient’s symptoms, adherence to medication, and potential adverse effects. Clinical Electrophysiology Discussion Paper

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Mr. Skemp’s ability to recognize angina symptoms, consume nitrate medication effectively, and realize when emergency care is necessary is greatly enhanced by patient education. As such, I would prioritize the management of risk factors, such as controlling hyperlipidemia with atorvastatin, maintaining strict control of blood pressure, and implementing anticoagulant therapy for atrial fibrillation. Furthermore, I would embrace a shared decision-making to foster an open sharing of ideas regarding treatment options and integrating Mr. Skemp’s preferences and concerns. Finally, I would consider teaming with experts, specifically his cardiologist, to facilitate an integrated and a thorough plan of care.

References

Heijman, J., Guichard, J. B., Dobrev, D., & Nattel, S. (2018). Translational challenges in atrial fibrillation. Circulation research, 122(5), 752-773. https://doi.org/10.1161/CIRCRESAHA.117.311081

Sarairah, S. Y., Woodbury, B., Methachittiphan, N., Tregoning, D. M., Sridhar, A. R., & Akoum, N. (2020). Esophageal thermal injury following cryoballoon ablation for atrial fibrillation. Clinical Electrophysiology, 6(3), 262-268.  Clinical Electrophysiology Discussion Paper

Mr. Skemp, a 76-year-old Asian American male patient, comes to your office today following a recent negative cardiac catheterization for angina chest pain. The patient has had four previous coronary stents, and it was determined that there was no blockage in the stents either. Prior to the catheterization, he was experiencing chest pressure, numbness in the left arm, and dyspnea that was brought on by exertion and exercise. He relates that the symptoms would dissipate soon after he rested. He would take sublingual nitrate often when he had the chest pain. He has a history of GERD, atrial fibrillation, has a pacemaker, and hyperlipidemia. He takes the following medications:

Digoxin 0.25 mg o.d. 

Metoprolol 25 mg bid 

Warfarin 7.5 mg o.d. 

Aspirin 81 mg o.d. 

Plavix 75 mg o.d. 

Losartan 25 mg o.d. 

Atorvastatin 20 mg o.d. 

Protonix 40 mg o.d. 

Mr. Skemp wants to know what treatment can be offered to him for his persistent chest discomfort. 
 Describe how you would address the patient’s needs and what may be included in your patient-centered treatment plan Clinical Electrophysiology Discussion Paper