Myocardial Infarction Case Study Question Essay

Myocardial Infarction Case Study Question

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You are the provider in a rural hospital setting and Mr. Smith, a 62-year-old man with a history of HTN was admitted last night for observation following an acute allergic reaction to Shellfish. You are set to discharge him late today as there were no reported events during the night. While you are completing your daily rounds, Mr. Smith complained of crushing substernal chest pain radiating to his neck and jaw on the left side and severe heartburn that had been going on for about an hour. The patient’s visiting family member noticed he became diaphoretic and pale and called a rapid response. You arrive to assess the patient, he has shortness of breath, and he reports heartburn, nausea, and lightheadedness after the onset of the “crushing” chest pain. Mr. Smith remembers one previous episode of chest pain that “didn’t last long” about a week ago while he was in Germany, he did not seek medical attention. He denies palpitations, vomiting, headache, blurred vision, numbness/motor weakness, abdominal pain, urinary symptoms, or fever/chills.

Allergies: shellfish and codeine

Social Hx: Patient is married, employed and travels abroad regularly; he reports drinking alcohol on occasion and denies smoking or illicit drug use.

ROS: Unable to complete at this time due to increasing SOB and distress.

PHYSICAL EXAM:

VS: HR 123, BP 88/60, Temperature 37.5, O2 90% on RA, RR 26

GENERAL: A&OX3, moderate distress

HEENT: PERRLA/EOMI

NECK: Supple, no lymphadenopathy, no JVD

CV: 2/6 systolic apical murmur, tachycardia, no PMI displacement

PULM: Tachipneic, Diffuse rales all lung fields

ABD: Soft, NT/ND, + BSx4

EXT: No C/C/E, palpable pulses all extremities NEURO: MAE X 4, CN II-VII grossly intact

Diagnostics: EKG shows ST elevation in leads V1-V6, I and aVL, Chest X-Ray indicates cardiogenic pulmonary edema.

Your Discussion should address the following:

What are your top three differentials for this cardiac patient with rationale? (think Cardiac Anatomy and Pathophysiology) Myocardial infarction, STEMI, cardiomyopathy, pericarditis, myocarditis, aortic disection, Pulmonary Embolus
What is your final diagnosis with rationale? Myocardial infarction of the LAD evident by cardiogenic shock (low BP), tachycardia, elevated ST in EKG, chest pain symptoms.
While awaiting Cardiology’s arrival, how will you manage and stabilize this patient? Oxygen, Nitrates, anticoagulation, analgesics like morphineplease be specific with current literature. please be specific with current literature.
What tests, labs and procedures do you expect Cardiology to order? Troponins x3, CKMB, Consents for cardiac angiogram with Percutenus Cardiac Intervention,etc. please be specific with current literature.
What benefit did being in the hospital give Mr. Smith in the outcome of this event? The time alloted in the intervention.
Be sure to include an abbreviated version of the case (in your own words) in the introduction of your Discussion Board initial post.

Example :
History of Present Illness: 79-year-old former smoker, male with a PMH of HTN, hyperlipidemia, COPD, Parkinson’s disease, Osteoarthritis, and depression who presented to the ED with c/o worsening cough at night after exercise x 3 weeks. Subsequently he c/o chest pain that occurred three nights prior to admission. Pain is described as a feeling of “heart coming out of chest” that lasted a few minutes and ultimately decided it was heart burn. Patient endorses recent exercise program at home but becomes out of breath and dizzy while working out. Prior to this he’s lived a sedentary lifestyle since retirement. Wife at bedside reports a decreased appetite, weight loss, memory changes, and difficulty with balance. Patient verbalized being scared and anxious that something may be wrong. On admission, patient is tachypneic with RR 29, tachycardic with HR 103, hypertensive BP 152/89, Sp02 90% on RA. On assessment, patient is positive for fatigue, forgetfulness, dizziness, conjunctival pallor, gait ataxia, palpitations with peripheral edema, cough, sob, mild LUQ pain and epigastric tenderness to deep palpation. Lab work shows anemia with a positive stool guaiac, hyponatremia, hypokalemia, hypoalbuminemia, elevated BUN/Creat, and elevated AST. CXR showed questionable opacity right mid-lobe, enlarged cardiac silhouette.

Myocardial Infarction Case Study Question Essay

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