Julie Thomas: Anxiety, Heart Attack Risk & Life Disruption - Case Study

Introduction

Julie Thomas is 48 years old and works as a clerk in the bank. The patient has central obesity, with a BMI of 32, and mild untreated hypertension. She goes to her GP, complaining that she experiences anxiety symptoms for the last six months. Having had a history of a heart attack in the family, she is worried that she could also have one. This condition and the fear have disrupted her normal life, including making her take sick leave from her job. During the session, she does not present any chest pains. She only has minor palpitations and shortness of breath at some point.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Initial Observations

Signs & Symptoms

• Julie has central obesity with a BMI of 32.
• Her current blood pressure is 145/87, indicating stage one hypertension.
• She has a resting heart rate of 92 beats per minute and a regular rhythm.
• Mild palpitations are present due to a slightly elevated heart rate.
• She reports having no chest pains during the interview.

Preliminary Investigations

Julie underwent an Electrocardiogram (ECG) two months ago. It showed a normal electrical conductivity in the heart. From the findings, all intervals were within the normal range, and there were no ischemic features in her cardiovascular muscles. Julie had also undergone a lipid profile analysis, which showed that her cholesterol level was normal.

Affective / Emotion Signs & Symptoms

Julie is a well-groomed in an official outfit. She took herself to the doctor and remained composed throughout the session without getting emotional.

She seems anxious and has a worried look on her face when she describes her condition to DR. Vehdi.

She starts with a somber mood and seems uncomfortable opening up to a new doctor. Talking about how her condition has affected her sex life makes her uncomfortable and shy.

However, reassurance from Dr. Vehdi puts her at ease and get more comfortable as the interview progresses. She warmed up as the session progressed and appeared more at ease, especially when the doctor described the pathophysiology of panic attacks. By the end of the session, she seems optimistic and relaxed.

Julie is conscious and impeccable memory about the onset and progression of the condition. She remembers all the details of her first panic attack, including the weather. She is alert and remains attentive and oriented to place and time throughout the interview. Besides, Julie listens actively by pays attention to everything the doctor says and responding accordingly. She does not have any symptoms of mental incapacitation and can logically articulate herself.

Thought content- During the interview, Julie states that she feels scared that she might have a heart attack since her father suffered the same. She also says that she is fed up with the situation as it wrecking her marriage and social life; she just wants it to be over.

Behavioral signs and symptoms- Julie remained seated upright throughout the session. However, she sat on the edge of the chair instead of a reclining back in a comfortable posture. She used her hands to demonstrate how her heart races and placed it on the chest to show how she finds it difficult to breathe properly when the attack happens. Also, Julie makes “boom” sounds to imitate how her heart races. Describing the symptoms makes her mouth dry, and her voice catches on her throat. Also, worried lines appear on her face, and she fidgets with her hands.

History

Medical history- Julie had appendectomy while she was 13 years old. She does not have a history of diabetes, and cholesterol level is within normal ranges. Also, she suffers from non-medicated mild hypertension and central obesity (BMI 32).

• Psychiatric history- Julie does not have a history of past anxiety disorders.
• Drug and Alcohol history- She does not smoke or use any recreational drugs
• Current social supports- Julie lives with her husband in Sydney, who has been helping her cope with the situation. However, he recently started getting fed up since she could not have sexual intercourse with him or accompany him to social events. Her son 24-year-old son cannot help since he loves lives in Melbourne
• Social circumstance- Julie lives with her husband in Sydney, who has to accompany her whenever she needs to go to town. She works as a bank clerk but has recently taken sick leave.
• Other Considerations- Julie does not drive. Her condition has made it impossible for her to go out with her husband or friends.
• Investigations- Blood samples were taken for thyroid function test, High sensitive C- reactive protein, and Troponin.

Case Study Report

What Is Going On Here?

The patient has central obesity, with a BMI of 32, and mild untreated hypertension. Her blood pressure and heart rate are slightly elevated (145/87 and 92 beats per minute, respectively). For the last six months, she has been anxious that her heart could have a problem since there is a history of a heart attack in her family. She suffers from regular palpations accompanied by chest pains and difficulty in breathing. Having had no intervention so far, she reports that nothing has changed. She still gets the same problem with the symptoms getting worse by day. This condition and the fear have disrupted her normal life, including making her take sick leave from her job. During the session, she does not present any chest pains. She only has minor palpitations and shortness of breath at some point.

The patient presents with signs of anxiety, which makes her think that her heart has a problem. She complains about experiencing episodes of racing heartbeat, chest pains, dry mouth, and shortness of breath. The symptoms had been going on for six months, and Julie thinks they will lead to a heart attack. As a result, she stopped going to town alone, hanging out with her friends, and having sex with her husband. Her BMI is 32, implying central obesity (Sahakyan et al., 2015). She also presents with slightly elevated blood pressure and heart rate consistent with her previous diagnosis of mild hypertension.

Julie appears well, composed, and physically fit. However, she seemed on edge and anxious during the appointment and admitted that she is worried that her heart has a problem. The patient presents with mild palpitations, which are preliminary symptoms of a panic attack. (Abbott, 2005). However, she reports having no chest pains. When the doctor asks her to describe the condition, she says that she feels uncomfortable and funny. Talking about the onset of her panic attacks makes her feel as if she will have one. Her voice catches on her throat, and she seems to have difficulty breathing until she inhales deeply. At this point, she appears vulnerable and has a worried look on her face. Her blood pressure and pulse would be elevated if recorded at that time, as predicted by Martinez et al. (2010).

The patient is anxious throughout the interview. She sits on the edge of the chair without reclining back, and worried lines appear on face when she describes her condition to the doctor. She also fidgets with her hands and lowers her voice, which, according to Marrs (2006), is a sign of anxiety. When describing how the condition has affected her daily life, Julie looks sad and helpless. She describes feeling fed up with the situation and wants it to end to get her life back on track. Julie’s anxiety results partly from having a history of heart disease in her family. Her father suffered a heart attack at 72 years old, causing his death. Considering some genes for cardiovascular problems are passed on from parents to offspring, Julie’s fear is valid. A survey by Berry et al. (2012) reported that the risk of cardiovascular diseases is higher in people with family members who suffered from the same.

The patient is alert and remains attentive and oriented to place and time throughout the interview. She participates actively in the conversation by answering and asking the doctor questions accordingly. She follows the discussion closely and seems to understand everything the GP says by nodding and agreeing verbally. Her memory is excellent, and there are no symptoms of mental incapacitation. From her description, her first panic attack occurred during hot weather while she was in town. It made her heart race and caused chest pains, shortness of breath, and dry mouth.

Julie’s panic attacks have been getting worse over time. This trend could be because she has not had any intervention so far, and she started avoiding triggers such as sex and exercise. Her heart rate also seems to be increasing (from 90 two months ago to 92 bpm today). During the appointment, Julie seems and admits to being stressed. Her current condition and the fear that comes with it have significantly affected her life. It made her take sick leave from work and stop going out with her husband and friends. At some point, she states that she is afraid of embarrassing herself if she goes out and gets a panic attack. This is consistent with the ‘fear of fear’ described by Rudaz et al. (2010).

Pathophysiology of Clinical Manifestation

Panic disorder is a type of anxiety disorder that occurs periodically. The first episode usually happens because of a particular trigger such as stress, medical condition, danger, grief, certain drugs, among others (Tubridy, 2008). They often present as a sudden onset of intense fear with debilitating physical symptoms that mimic a heart attack. Occasionally, panic attacks can occur spontaneously without a clear trigger as it happened when Julie was walking in town (Meuret et al., 2011). It is normal for healthy people to have anxiety at certain times. Mawson (2005) states that are panicking and feeling anxious are normal responses to dangerous or stressful situations. However, these feelings can occur for no apparent reason at any time for people who have panic disorders like Julie.

In the current case, Julie’s first trigger was pressure at work. She reported feeling stressed since they got a new boss and a new computer system in the office. According to Kim et al. (2012) and Pfleiderer et al. (2007), such stress sends nerve signals to activate the amygdala, the part of the brain that controls anxious response. This activation then triggers the production of adrenaline (epinephrine) from the adrenal glands. The hormone is responsible for the body’s fight or flight mechanism (Pfleiderer et al., 2007). When there is no imminent danger, the body does not need adrenaline to fight or run. This chemical instead builds up in the system, causing symptoms of a panic attack like the ones Julie reported experiencing.

An accumulation of adrenaline in the bloodstream puts the body on high alert. The heart rate goes up to speed the supply of blood around the body, particularly to the muscles in preparation for fight or flight. This change causes the heart to race, as reported by Julie. In this situation, the body directs most of its oxygen and energy to the muscles, which causes air passages to dilate (Derrick et al., 2019). The increased demand for air results in an increased breathing speed (hyperventilation). However, the hormone also comes with a debilitating fear that the patient will have a heart attack making it even more difficult to breathe. Patients end up gasping for air, which makes them feel like their mouth is dry.

Adrenaline also triggers blood vessels to constrict to try to redirect oxygen and glucose to the vital organs like the heart and lungs, as well as other major muscles. According to Schenberg et al. (2008), this vasoconstriction causes the blood pressure to rise to increase the speed of flow blood that further causes the heart to race. Epinephrine also causes constriction...