You are the R.N. assigned to four patients on the cardiac medical unit. The first patient is a 51-year-old male. He was diagnosed with coronary artery disease (CAD) and hypertension (HTN) 2 years ago. He underwent a cardiac catheterization at that time and results showed 50% stenosis of the right coronary artery. He was prescribed metoprolol (Toprol), atorvastatin (Lipitor), and prn Nitroglycerin (for episodes of chest pain) at the time of his diagnosis. He presented to the ED yesterday with complaints of dizziness and intermittent chest pain in the past 10 days. EKG demonstrates normal sinus rhythm upon admission. He has been unable to follow his exercise routine without feeling “wiped out” for the past month. His father died of a heart attack when he was 50.
Current Subjective Data:
S.J. complains of increased fatigue, especially with activity. He has been unable to follow his exercise routine as a result of this. He states he has had to take his Nitroglycerin tablets 10 times over the past week for chest pain.
Current Objective Data:
Physical Examination
Vital Signs are as follows: Temperature 97.9° F (36.6° C), Blood pressure (BP) 148/83mm Hg, Heart rate irregular at 115 beats//min, Respiratory rate 18 breaths/min.
The decision is made to start S.J. on diltiazem (Cardizem) intravenously and within the hour he converts to a normal sinus rhythm. He is monitored closely and remains in normal sinus rhythm. The decision to convert S.J. to oral medication is made.
4. What is the primary complication that could occur if this rhythm were not corrected and what medications will be prescribed in order to address this complication? Cite the references.