Question: 3.2) Group 1 E AF Is A 58 Yowf Who Presents To Your Office For Follow-up Of Angina Pectoris. At Her Last Visit: She Was Started On Nitroglycerin Transdermal Patch (Nitro-Dur) 0.4mg./hr Qahrid Nitroglycerin (Nitrostat) 0.4mg Sublingual Tablets PRN Chest Pain. She States That During The First Week Of Therapy, The Number Of Anginal Episodes Decreased From …

3.2) Group 1 e AF is a 58 yowf who presents to your office for follow-up of angina pectoris. At her last visit: she was started on nitroglycerin transdermal patch (Nitro-Dur) 0.4mg./hr Qahrid nitroglycerin (Nitrostat) 0.4mg sublingual tablets PRN chest pain. She states that during the first week of therapy, the number of anginal episodes decreased from 4-5 per week to 1-2 per week. Thereafter the episodes returned to 4-5 per week. All of these anginal episodes occurred during physical exertion and were relieved by rest and administration of one sublingual nitroglycerin tablet. AF is able to walk 4 to 5 blocks before chest pain usually develops. She denies fatigue, SOB, orthopnea, or paroxysmal nocturnal dyspnea. Recent cardiac catheterization revealed no new blockages. PMI: AF had a lateral myocardial infarction (MD) in November 2005. She also has a history of mild CHF, chronic atrial fibrillation, and hypercholesterolemia. Medications: Furosemide (Lasix) 40mg daily Metoprolol succinate (loprol XLM) 100 mg daily Warfarin (Coumadin)3mg daily Lovastatin (Mevacor) zomg at bedtime Potassium chloride (K-Dur) zomEq daily Nitroglycerin patch (Nitro-Dur) 0.4mg/hr (24hr Nitroglycerin (Nitrostat) 0.4mg tablets as needed Physical Examination: GEN: adult female in NAD VS: BP 136/82, P-ventricular response 62 and irregular, RR 18, Wt 53.2kg HEENT: PERRLA COR: S1, S2 and S3 heart sounds, no JVD or HJR, no murmur CHEST: clear to auscultation and percussion ABD: soft, nontender with bowel sounds GU: WNL RECT: WNL EXT: normal pulses throughout, no peripheral edema NEURO: cranial nerves II-XII grossly intact, oriented X 3 Laboratory: WNL . Group 1 Case Questions: What problems can you identify and what subjective/objective information supports the problems identified What could possibly explain the decrease in angina symptoms after the start of therapy followed by an increase in episodes? How would you treat this patient’s angina? Take one problem identified above and indicate your assessment and plan (is therapy ideal, would you change anything, goals of therapy, monitoring…)