A patient complains of chest pain and a tingling sensation, which radiates to the left shoulder and left hand. All of the following are risk factors EXCEPT?

Appeared in: SGPGI Nursing Officer-2024

Explanation

A low-sodium diet is a therapeutic intervention, not a risk factor for heart disease.
It is specifically recommended to help control hypertension (high blood pressure), which is a major risk factor for coronary artery disease (CAD).
Therefore, adopting a low-sodium diet is a protective action intended to reduce cardiovascular risk.

Option A: High cholesterol is a primary risk factor for atherosclerosis, the underlying process of CAD. Elevated LDL cholesterol contributes directly to plaque buildup in arteries.
Option B: Smoking is one of the most significant modifiable risk factors for CAD. It damages blood vessels, promotes clotting, and accelerates the atherosclerotic process.
Option C: Obesity is an independent risk factor for CAD and is also strongly linked to other risk factors like hypertension, diabetes, and hypercholesterolemia.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risk factors for Myocardial Infarction (MI) and Coronary Artery Disease (CAD) to guide bedside assessment, documentation, and the next nursing action.
Nurses have a crucial role in educating patients about identifying and managing modifiable risk factors for CAD to prevent both primary and secondary cardiac events.
A thorough nursing assessment for a patient with chest pain must include a detailed history of cardiovascular risk factors to help determine the likelihood of a cardiac cause and guide immediate care.
What if? If the patient also had a family history of heart disease before age 55, this non-modifiable risk factor would significantly elevate their overall risk, making the aggressive management of modifiable factors like diet and cholesterol even more critical.

How to Approach the Question

First, analyze the patient's symptoms (chest pain radiating to the left arm) to identify the likely clinical condition, which is suggestive of angina or myocardial infarction.
Next, carefully read the lead-in keyword 'EXCEPT'. This means you are looking for the option that is NOT a risk factor for the condition.
Evaluate each option's relationship to heart disease. Recall that high cholesterol, smoking, and obesity are well-established, major risk factors.
Identify the option that represents a protective or therapeutic measure. A low-sodium diet is a dietary recommendation to lower blood pressure and reduce heart disease risk.
Conclude that the low-sodium diet is the exception and therefore the correct answer.

Concept Tested & Keywords

Concept Tested: Risk factors for Myocardial Infarction (MI) and Coronary Artery Disease (CAD)
Stem keywords: chest pain, tingling sensation, radiates to left shoulder, left hand, risk factors
Lead-in keywords: EXCEPT
Clinical cues: The pattern of radiating chest pain is a classic sign of angina or myocardial infarction.
Negative lead-in flag: This question uses the negative keyword 'EXCEPT', requiring identification of the option that is not a risk factor.

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E6 Medicine Davidson Principles Practice 24e p. 506-508

E6 Medicine Harrison 22e Part 2 p. 237-239

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 1 (pp 26-370 of 370) p. 262-264

Practise the full SGPGI Nursing Officer-2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.