It plaque has a fibrous cap made of

It can be noted
that the acute pathophysiological condition that has led to Dean’s current
presentation is, unstable angina that has also caused a right sided myocardial
infarction.

To begin, unstable
angina is categorized as an acute coronary syndrome, which means that it is a
condition in which there is some form of blockage preventing blood to the
myocardium (“Acute Coronary Syndrome” 1). It is
caused due to atherosclerosis, which is when the arteries begin to narrow and
prevent the heart from receiving oxygen (Sullivan 1). The most common cause of
unstable angina is when atherosclerotic plaque in the coronary artery ruptures
(“Unstable Angina” 1). The
plaque has a fibrous cap made of epithelial cells, which, if destroyed can lead
to exposure of cholesterol or calcium (Button 22). This causes platelets to
gather on the exposed plaque and arteries can become blocked if too many
platelets accumulate together (Button 22). Ultimately, this creates a decreased
blood supply to the myocardial tissue and can cause infarct (Button 22). This
may also lead to necrosis if this issue is not addressed (Button 22).  

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It is clear
that Dean is presenting with unstable angina due to several factors. Firstly,
he has chest pain that radiates in his back and shoulders (“Unstable Angina”
1). Dean is also overweight, over forty-five-years old and male which makes him
more at risk for this condition (“Unstable Angina” 1). The reason that this is
not likely stable angina is due to the fact that his chest pain is existing
while at rest and is lasting for a period of longer than twenty minutes (Sullivan
1).

Next, it can be
noted that Dean has high cholesterol and high blood pressure based on the
medication list provided. He takes Bisoprolol fumarate and Irbesartan-Hydrochlorothiazide
to treat his hypertension (“Irbesartan-Hydrochlorothiazide” 1). In addition,
Dean takes Atorvastatin calcium to lower his cholesterol as a way to reduce his
risk of cardiovascular disease (“Atorvastatin calcium” 1). Having high blood
pressure and high cholesterol also puts Dean at a higher risk for unstable
angina (“Unstable Angina” 1).  

Following,
due to the fact that Dean has a grey skin colour, it is evident that the ruptured
plaque has led to an inadequate blood flow around the body (Baker 1). This lack
of oxygen can also explain the mottling in his hands and legs (Baker 1).

 

Dean
is also profusely sweating, dizzy and has vomited. These are all symptoms of unstable
angina (“Unstable Angina” 1). Lastly in regards to unstable angina, the hearth
rhythm presented on the monitor is called atrial fibrillation (Riedl 1). It is
commonly seen in patients with any type of angina as blood to the ventricle is
impeded. This is why Dean is presenting with this rhythm (Riedl 1).  

 

The
reason that it is likely that the unstable angina has led to a right sided
myocardial infraction is seen based on his vital signs. Dean has a slow heart
rate, that is also weak and irregular. The reason for a slow heart rate is due
to the fact that the sinoatrial node and the atrioventricular node in the right
atrium are compromised due to a blockage of the right coronary artery (Button
39). This blockage is also the reason for an absence in his peripheral pulses
as a full occlusion of the artery causes a decrease in distal blood flow
(Button 39). Dean is also presenting with a low blood pressure which explains
the low cardiac output (Button 39). Thirdly, there are no adventitious sounds
heard in upon auscultation, which is also a clear sign that a right sided
myocardial infarction has led to Dean’s current presentation (Singh 1).