The nurse is doing discharge teaching with a client who has coronary artery disease.

The client asks why he has to take an aspirin every day if he doesn’t have any pain.

What would be the nurse’s best response?

Cardiac tamponade is a life-threatening condition that occurs when fluid accumulates in the pericardial sac, the thin, doublelayered membrane that surrounds the heart. This fluid buildup compresses the heart, preventing it from filling properly and pumping blood effectively.

The classic triad of symptoms of cardiac tamponade is muffled heart sounds, jugular vein distention (JVD), and hypotension.

Muffled heart sounds occur because the fluid in the pericardial sac dampens the sound of the heart's valves closing. JVD occurs because the fluid in the pericardial sac compresses the superior vena cava, which is a large vein that carries blood from the upper body back to the heart. Hypotension occurs because the compressed heart is unable to pump blood effectively.

Other signs and symptoms of cardiac tamponade may include:

Tachycardia (rapid heart rate)

Dyspnea (shortness of breath)

Chest pain

Pulsus paradoxus (a drop in blood pressure during inspiration)

Anxiety or restlessness

Altered mental status

Cardiac tamponade is a medical emergency that requires immediate treatment. The goal of treatment is to relieve the pressure on the heart by removing the fluid from the pericardial sac. This is typically done through a procedure called pericardiocentesis, which involves inserting a needle into the pericardial sac and draining the fluid.

Choice B rationale:

Artery dissection is a condition that occurs when the inner layer of an artery tears, allowing blood to flow between the layers of the artery wall. This can lead to a number of complications, including aneurysm formation, rupture, and ischemia (lack of blood flow) to the organs and tissues supplied by the affected artery.

The signs and symptoms of artery dissection vary depending on the location of the dissection. Common symptoms include sudden, severe pain; weakness or numbness; and a difference in blood pressure between the arms or legs.

Artery dissection is a serious condition that requires prompt medical attention. Treatment options may include medication, surgery, or a combination of both.

Choice C rationale:

It is not normal to have muffled heart sounds, JVD, and hypotension following stent placement. These are signs of a serious complication, such as cardiac tamponade or artery dissection.

Choice D rationale:

Myocardial infarction (MI), also known as a heart attack, occurs when blood flow to a portion of the heart is blocked, causing damage to the heart muscle. The classic symptom of an MI is chest pain, but other symptoms may include shortness of breath, nausea, vomiting, sweating, and lightheadedness.

The signs and symptoms of cardiac tamponade and MI can overlap, but there are some key differences. For example, chest pain is more common in MI, while JVD is more common in cardiac tamponade.

The correct answer is A. Electrocardiogram.

Choice A rationale:

Electrocardiogram (ECG) is the priority diagnostic procedure for a suspected myocardial infarction (MI) due to several compelling reasons:

Rapidity: An ECG can be performed quickly and easily at the bedside, providing immediate results within minutes. This swiftness is crucial in the context of MI, where time is of the essence to initiate appropriate treatment and salvage viable heart tissue.

Sensitivity: The ECG is highly sensitive in detecting the electrical changes that occur during an MI. It can identify characteristic ST-segment elevation or depression, T wave inversions, and other abnormalities that strongly suggest myocardial ischemia or infarction.

Specificity: While not perfectly specific for MI, the ECG can often distinguish it from other conditions that may cause chest pain, such as pericarditis or pulmonary embolism. This diagnostic differentiation is crucial for guiding appropriate management.

Non-invasiveness: The ECG is a non-invasive procedure that does not involve any needles, catheters, or exposure to radiation. This makes it a safe and readily accessible test, even for patients who may be hemodynamically unstable or have other medical conditions.

Cost-effectiveness: The ECG is a relatively inexpensive diagnostic tool compared to other imaging modalities like echocardiography or cardiac angiography. This cost-effectiveness makes it a valuable first-line test in evaluating potential MI, allowing for efficient resource allocation.

Rationales for other choices:

Choice B (Papercut): This is not a relevant diagnostic procedure for MI and is therefore incorrect.

Choice C (Cardiac Angiogram): While cardiac angiography can definitively visualize coronary artery blockages, it is an invasive procedure that carries risks and requires specialized facilities and personnel. It is typically reserved for cases where the diagnosis remains uncertain after non-invasive testing or when intervention is planned.

Choice D (Echocardiogram): Echocardiography can assess heart function and detect structural abnormalities, but it is less sensitive than ECG for the early electrical changes of MI. It may be used as an adjunct test to provide additional information, but it is not the priority procedure in the initial evaluation.