Case Study: John Smith Sample

Subject Name : Medical Science

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