A 49-year-old female experienced a sudden, crushing substernal pain in her chest that radiated along the medial aspect o
Posted: Mon May 23, 2022 2:50 pm
A 49-year-old female experienced a sudden, crushing
substernal pain in her chest that radiated along the medial aspect
of her left arm while having a heated discussion with her husband.
Her husband helped her to the couch where the patient attempted to
relieve the pain by squirming, stretching, and belching. When her
husband noted that she was pale, perspiring, and writhing in pain,
he called for an ambulance. The paramedics administered oxygen and
rushed her to the emergency room. After evaluation, she was
admitted to the intensive care unit (ICU) since the pain, although
diminished, was still present nearly 40 minutes after the event’s
onset. She was placed under observation with EKG monitoring for
detection of potential fatal arrhythmias. She was noted to be
hypotensive.
While doing your rounds as a resident, you learn that
the patient has had previous attacks of substernal discomfort
during stressful situations that she was reluctant to describe as
pain. She said that this discomfort always passed when she rested.
When you ask the patient to describe her current chest discomfort,
she said that it was the worst sensation she had ever felt and
clenched her fist to demonstrate its vise-like nature. She said
that when the episodes occurred, she had a feeling of weakness and
nausea. While completing a physical examination, you detect an
occasional arrhythmia on auscultation. The patient is noted to have
abnormal EKG results. Her lab work suggested of elevated serum
levels of substances confirming myocardial necrosis. The patient is
diagnosed with acute myocardial infarction (MI) caused by coronary
atherosclerosis.
Questions:
1. Define acute MI and coronary
atherosclerosis.
2. Explain the anatomical basis of referred pain from
the patient’s heart to the left side of her chest, shoulder, and
medial aspect of her arm.
3. What are some specific significant findings in her
lab work that support the patient's diagnosis?
4. What are some specific abnormal EKG findings that
support the patient's diagnosis?
5. If the patient were to undergo a cardiac
catheterization procedure, what are some significant findings
associated with the patient's diagnosis? Be specific with
structures.
substernal pain in her chest that radiated along the medial aspect
of her left arm while having a heated discussion with her husband.
Her husband helped her to the couch where the patient attempted to
relieve the pain by squirming, stretching, and belching. When her
husband noted that she was pale, perspiring, and writhing in pain,
he called for an ambulance. The paramedics administered oxygen and
rushed her to the emergency room. After evaluation, she was
admitted to the intensive care unit (ICU) since the pain, although
diminished, was still present nearly 40 minutes after the event’s
onset. She was placed under observation with EKG monitoring for
detection of potential fatal arrhythmias. She was noted to be
hypotensive.
While doing your rounds as a resident, you learn that
the patient has had previous attacks of substernal discomfort
during stressful situations that she was reluctant to describe as
pain. She said that this discomfort always passed when she rested.
When you ask the patient to describe her current chest discomfort,
she said that it was the worst sensation she had ever felt and
clenched her fist to demonstrate its vise-like nature. She said
that when the episodes occurred, she had a feeling of weakness and
nausea. While completing a physical examination, you detect an
occasional arrhythmia on auscultation. The patient is noted to have
abnormal EKG results. Her lab work suggested of elevated serum
levels of substances confirming myocardial necrosis. The patient is
diagnosed with acute myocardial infarction (MI) caused by coronary
atherosclerosis.
Questions:
1. Define acute MI and coronary
atherosclerosis.
2. Explain the anatomical basis of referred pain from
the patient’s heart to the left side of her chest, shoulder, and
medial aspect of her arm.
3. What are some specific significant findings in her
lab work that support the patient's diagnosis?
4. What are some specific abnormal EKG findings that
support the patient's diagnosis?
5. If the patient were to undergo a cardiac
catheterization procedure, what are some significant findings
associated with the patient's diagnosis? Be specific with
structures.