Case Study: Heart Disease

Florence Jones is a 70 year old retired nurse, who was widowed ten years ago. She now
lives alone in a two bedroom semi-detached property, and has two grown up children and
five grandchildren who live locally. Florence is a fit and active lady, who enjoys socialising
with her friends and holidaying abroad with her family. Florence’s mother died in her forties
following a cerebral vascular accident and her father died in his sixties following a
myocardial infarction. Florence has enjoyed good health generally, but five years ago was
commenced on an ACE inhibitor and a statin, and is currently taking Lisinopril 80mg and
Simvastatin 40mg daily. For the past twenty years, Florence has been the main carer for her
65 year old brother who suffers from mental health problems and her 80 year old sister who
has a learning disability. Although they have social care in their own homes, consisting of 4
visits daily to attend to their personal needs, Florence also visits daily to help with
housework, shopping and managing their financial affairs.

Over the last few months, Florence has become aware of increasing breathlessness on
exertion, particularly when walking upstairs. She has also experienced some intermittent
chest pain, which has resolved itself upon rest, but failed to tell anyone about this. Following
a period of illness due to influenza, Florence divulged this to her daughter who insisted that
she seek some advice from her GP. Reluctantly, Florence attended an appointment with her
GP who performed an ECG. The ECG showed some abnormalities but was inconclusive, so
Florence was referred to a cardiologist. A month later, she attended the cardiology
appointment and a repeat ECG identified further abnormalities, which suggested that
Florence had previously experienced a minor myocardial infarction. Her blood pressure was
also noted to be extremely high at 225/156. The cardiologist was extremely concerned about
this and commenced her on Bisoprolol 5mg and Aspirin 75mg daily. Florence is currently
awaiting further investigations as an outpatient, which include a cardiac ultrasound scan and
angiogram. As a result, Florence is extremely anxious and this has impacted on her desire to
spend time with her friends, whilst caring for her brother and sister has become increasingly
difficult. Florence has a reduced appetite, looks pale and appears withdrawn. Her children
are concerned about her, but Florence insists that all will be well once she has had the
impending investigations and is aware of the results.