Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
- For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
- Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Full Answer Section
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- Physical Inactivity: Lack of physical activity increases the risk of obesity, hypertension, and other cardiovascular diseases.
- Poor Diet: A diet high in saturated and trans fats, cholesterol, and sodium can increase the risk of heart disease.
- Excessive Alcohol Consumption: Heavy alcohol consumption can damage the heart muscle and increase the risk of arrhythmias.
- Stress: Chronic stress can contribute to the development of hypertension, increased heart rate, and other cardiovascular problems.
- Drug Use: Cocaine and other illicit drugs can significantly increase the risk of heart attack.
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Non-Modifiable:
- Age: The risk of heart disease increases with age.
- Sex: Men are generally at higher risk for heart disease than women, but the risk increases for women after menopause.
- Family History: A family history of early heart disease increases individual risk.
2. Expected EKG Findings and Compatible Case Findings:
3. Most Specific Laboratory Test:
- Troponin:
- Rationale: Troponin is a protein found in heart muscle cells. When the heart muscle is damaged, as in a myocardial infarction, troponin is released into the bloodstream.
- Specificity: Troponin is a highly specific biomarker for myocardial injury. Serial troponin measurements (at presentation and 3-6 hours later) are crucial for diagnosing acute myocardial infarction.
4. Explanation of Fever:
- Fever after Myocardial Infarction:
- Pathophysiology: Myocardial infarction leads to the release of inflammatory mediators, such as cytokines, which can trigger a systemic inflammatory response. This inflammatory response can cause fever, which typically develops within the first 24-48 hours after the onset of chest pain.
- Clinical Significance: Fever after a myocardial infarction can indicate the extent of myocardial injury and may be associated with a worse prognosis.
5. Explanation of Chest Pain:
- Mechanism: Chest pain in myocardial infarction arises from myocardial ischemia, which occurs when the blood supply to the heart muscle is reduced or blocked.
- Atherosclerotic Plaque Rupture: Atherosclerosis, the buildup of plaque within the coronary arteries, is the primary cause of myocardial infarction. Plaque rupture can lead to the formation of a blood clot, obstructing blood flow to the heart muscle.
- Ischemia and Pain: When the heart muscle is deprived of oxygen, it experiences ischemia, which results in chest pain. The severity and location of the pain can vary depending on the location and extent of the blockage.
Sample Answer
This is for informational purposes only. For medical advice or diagnosis, consult a professional.
1. Risk Factors for Coronary Artery Disease and Myocardial Infarction
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Modifiable:
- Smoking: Cigarette smoking is a major risk factor for coronary artery disease (CAD) and myocardial infarction (MI).
- Hypertension: High blood pressure puts increased strain on the heart and arteries.
- Hyperlipidemia: Elevated levels of cholesterol, particularly low-density lipoprotein (LDL) cholesterol, contribute to plaque buildup in the arteries.
- Diabetes: Diabetes mellitus significantly increases the risk of developing CAD and experiencing complications such as heart attack and stroke.
- Obesity: Obesity is associated with increased risk of hypertension, diabetes, and other cardiovascular risk factors.