Recommendations for the treatment of angina pectoris

Angina is characterized by pains in the chest that are caused by the lack of blood in the heart muscle. Mr. JS has chronic stable angina which means that his pain is long-lasting and severe. The chest pains might be triggered by emotional stress. Mr. JSs chronic stable angina is accompanied by hypertension. This medical condition implies that the blood pressure (BP) is persistently higher than the recommended ones. The current paper discusses the case of Mr. JS and proposes a solution for his health problem.

The guidelines on hypertension released by the American Heart Association suggest that the patients suffering from chronic stable angina and hypertension should have “a BP target of less than 130/80 mm Hg” (Whelton et al., 2018, e43). Patients diagnosed with chronic stable angina should follow a healthy diet and lifestyle. The study conducted by Maxwell et al. (2002) reveals that patients with stable angina should eat food rich in arginine because it helps to improve vascular function and exercise capacity. In addition to the modifications in diet and lifestyle, the patients should take beta-blockers to control their BP (Whelton et al., 2018). The intake of beta-blockers allows increasing “exercise time until the onset of angina pectoris, reducing exercise-induced ischemic ST-segment depression” (Whelton et al., 2018, e49). The American Heart Association recommends taking such beta-blockers as “carvedilol, metoprolol tartrate, metoprolol succinate, nadolol, bisoprolol, propranolol, and timolol” because they are “effective in lowering BP” (Whelton et al., 2018, e49).

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A patient related to the case presented should be asked several questions during the appointment. First of all, hypertension and CAD are closely linked with a diet and lifestyle of a patient (Rosendorff et al., 2015). Therefore, a physician should ask a patient to describe his average diet and estimate his daily physical activity level. In addition to that, a physician should figure out whether a person has already been diagnosed with angina. In case he knows his diagnosis, it is necessary to ask whether a patient is taking the prescribed medications. Finally, a physician should measure the blood pressure of a person who came for an appointment. For these measurements to be correct, a doctor should ask if a patient was physically active, for example, walking faster than usual, before coming into the appointment. These questions are necessary because they enable a practitioner to understand the possible causes of high blood pressure and undertake proper measures to improve a patients health.

Mr. JS suffers from a PMH of HTN which means that the cause of his high BP lies in the hypertensive putaminal hemorrhage. According to Whelton et al. (2018), laboratory tests are used for patients diagnosed with hypertension for the first time when the causes of the problem are unclear. Mr. JSs diagnosis has already been made, and he takes medicines for a while, but his BP remains high. Therefore, he should be tested for secondary hypertension via screening tests.

Mr. JS takes 10 mg of metoprolol tartrate twice a day, whereas the American Heart Association recommends taking from 100 to 200 mg of this beta-blocker a day. Therefore, it is necessary to increase the daily intake of metoprolol tartrate from 20 mg/ day to at least 100 mg/day. The increase in the dosage of metoprolol tartrate will help Mr. JS to lower his high BP.

References

Maxwell, A. J., Zapien, M. P., Pearce, G. L., MacCallum, G., & Stone, P. H. (2002). Randomized trial of a medical food for the dietary management of chronic, stable angina. Journal of the American College of Cardiology, 39(1), 37-45. Web.

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Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S.,… & White, W. B. (2015). Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation, 131(19), e435-e470. Web.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C.,… & Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(6), e13-e115. Web.

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