AH314-Pathophysiology
Case Study 4
Myocardial Infarction
K.R. is a 46-year-old man admitted to the emergency department with unremitting chest discomfort. The pain started while he was shoveling snow from his walkway. He had experienced chest discomfort with activity previously, but the pain had subsided with rest and he sought no medical help. This time the pain did not subside and became increasingly severe, radiating to his left arm and lower jaw. In the emergency department, an ECG and cardiac enzymes were obtained. The cardiac monitor showed sinus tachycardia with occasional premature ventricular complexes. After receiving results of his ECG and cardiac enzymes, the physician diagnoses K.R. with a myocardial infarction (MI).
1. What electrocardiographic (ECG) changes would indicate that K.R. is experiencing a MI? (3 points; List 3 ECG changes that would indicate MI.)
ST elevation is a pattern where the slope will go upward horizontal or in a dome-shape.
ST depression this pattern is seen as a horizontal or down- sloping depression.
Pathological Q waves is wider than a normal Q wave and deeper. (medicine-on-line.com, n.d.)
2. What changes in “cardiac enzymes” would be consistent with a diagnosis of MI? (4 points; List and describe 3 cardiac enzyme changes consistent with MI.)
From the article “Cardiac Enzymes and Markers for Myocardial infratction” by Dr. Colin Tidy (2014), I was able to summarize these cardiac enzyme changes.
Creatine kinase is a myocardial muscle
Assessment 2 Short Essay Question -01 Discuss Mr. Ronald bates systemic assessment and priorities of management Mr. Ronald bates presented to the emergency department with shortness of breath (Respiratory rate- 24 breaths/min) and general discomfort (pain score- 4/10) and it was started in the morning and worsens when doing activities. The above presenting complaints lead to a possible cardiac event, so that this presentation would be triaged as category 2. Therefore, medical officer would be notified regrading patient presentation and put Mr. bates to semi fowler’s position in the Emergency bed if this position is comfortable for him. Further primary systemic assessment of the patient starts with an order with an assessment of
Figure 1 shows the electrocardiogram (ECG) after the angiography. A carotid endarterectomy was performed 5 months before due to an atheroembolic stroke. During the postoperative period, she presented atrial fibrillation with rapid ventricular response and amiodarone was added to her habitual treatment. Her current treatment is ASA 325 mg/day, atenolol 50 mg bid, enalapril 20 mg bid and amiodarone 200 mg bid. One month before the event she attended the outpatient clinic and an echocardiogram was performed, which showed: normal left ventricular dimensions, wall thickness mildly increased, normal left atrium and aorta, mild left ventricular dysfunction with an estimated ejection fraction of 50%, hypokinetic basal inferior and mid inferior segments and mitral inflow filling pattern of delayed relaxation (according to her age).
No JVD. No cyanosis, clubbing, or edema. 2+ pulses bilaterally at the carotid artery. 1+ pulses bilaterally at radial, DP, and PT arteries. No murmur or change in cardiac status with 1 min of vigorous activity in the office.
The only known heart problems were rheumatic fever and "soldier's heart". Doctors would rely on the methods of percussion and
Angina, Myocardial Infarction, and Cardiac Arrest Comparison and Contrast Hannah Bunce Fayetteville Technical Community College Angina, Myocardial Infarction, and Cardiac Arrest Comparison and Contrast Three of the most commonly occurring cardiac related events: angina, myocardial infarction, and cardiac arrest, are commonly confused. However, there is a huge difference between each of them. It is crucial to be informed of each of these cardiovascular emergencies and to be able to differentiate between them. As a medical professional it is also very important to know the appropriate care for each these cardiac related emergencies.
Generate: Heart auscultation is useful in characterizing heart sounds and identifying abnormalities that may suggest cardiac dysfunction.1 The fourth heart sound (S4 atrial gallop), heard during the patient’s physical examination, is often an abnormal finding due to reduction in ventricular wall compliance.1,2 Additionally, S4 occurs due to rapid deceleration of active blood flow due to a nondistensible ventricle.2 S4 can be heard in patients with hypertension, hypertrophic cardiomyopathy and acute myocardial infarction (AMI).1,2
Cardiac causes. 4.4. Cerebrovascular causes. 4.5. Other causes.
Thank you very much for referring Glenys along for further investigation of the abnormalities detected on the CT scan of her chest which was done for investigation of night sweats. As you have mentioned, she has seronegative rheumatoid arthritis for which she is normally on prednisolone, methotrexate and Arava, but the methotrexate and Arava have been stopped recently due to an elevated liver function test. The CT scan of her chest, abdomen and pelvis did not reveal any cause for her night sweats but did reveal the presence of mild, mid and upper lung paraseptal emphysema with some non-specific scarring in the basal segment of the right lower lobe basal lingula and anterior basal left lower lobe. There were multiple scattered small irregular cysts elsewhere throughout the lung. Alongside this, there were also two small pulmonary nodules in the right middle lobe and right lower lobe which were 3mm.
Severe global ventricular dysfunction may also be noted during the FAST exam, more likely the result of severe acidosis from hypovolemic shock than blunt cardiac injury. Although blunt cardiac rupture is rare,
For each abnormal value, describe what physiological effect it might have on the patient. Connect each of your descriptions to one or more of the symptoms Harold has been experiencing.
B. Learning Objectives: (List 2-4 of your clinical objectives from your week/group of shifts – remember, you should begin each shift with 2-3 clinical objectives.) 1. Practiced neonatal head-to-toe assessments. 2. Give a shift report to the oncoming nurse.
This type of shock occurs when the heart is unable to pump blood effectively. This is evident to patients who have had myocardial infarction, such as John’s case. In this illness, the heart has decreased contractility resulting to decreased cardiac output. Such decrease will stimulate the sympathetic nervous system to activate the compensatory mechanism by increasing the heart rate as evident in John’s vital sign to increase the peripheral pressure and ventricular
23. Myocarditis infarction does permanent damage to part of the heart muscle due severe lack of blood flow. 24. Cardiodynia is when an individual experience pain in the heart. 25.
Myocardial Infarction which is another word for Heart-attack. When you have an heart-attack your blood is not getting to your heart's muscle. This means your arteries are clogged. Blood is pumped through your arteries to all of the parts in your body. If you have a heart condition you shouldn't smoke, you should diet and exercise, you should watch your Blood Pressure if you have to take medication for your Blood Pressure make sure you take the prescribed medication.
Kent, M., 2013. Advanced biology, 2nd ed. Laizzo, P., 2016. HANDBOOK OF CARDIAC ANATOMY, PHYSIOLOGY, AND DEVICES. SPRINGER, S.l.