ANTIANGINAL DRUGS

Brief History. T.M. is a 73-year-old man who is retired from his job as an accountant. He has a long history of type 2 diabetes mellitus, which has progressively worsened over the past decade despite oral antidiabetic medication and insulin treatment. He also has a history of stable (classic) angina that has been managed by nitroglycerin. The patient self-administers a nitroglycerin tablet (0.4 mg) sublingually at the onset of an anginal attack. Recently, the patient was admitted to the hospital for treatment of a gangrenous lesion on his left foot. When this lesion failed to respond to conservative treatment, a left below-knee amputation was performed. Following the amputation, the patient was referred to physical therapy for strengthening and a preprosthetic evaluation.

Problem/Influence of Medication. The therapist initiated a program of general conditioning and strengthening at the patient’s bedside the day following surgery. On the third day, the therapist decided to bring the patient to the physical therapy department for a more intensive program, including standing activities with the parallel bars. The patient arrived in the department via wheelchair and began complaining immediately of chest pains. The patient had not brought his nitroglycerin tablets with him to the therapy session.

1. What immediate action should the therapist take to help this patient during an angina attack?

2. Why did T.M. experience angina before even beginning any exercises or other rehabilitation regimens?

3. What can be done to prevent similar situations in the future?