cardiac case studies Joanne Hung
CS 2: 15 points 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. K.R. was treated with 2 L nasal oxygen, tissue plasminogen activator, sublingual nitroglycerin, and IV morphine sulfate. When he was pain free, he was transferred to the cardiac unit for monitoring.
Discussion Questions
1. What changes in “cardiac enzymes” would be consistent with a diagnosis of MI?
Troponins(I and T specific to cardiac muscle cells), elevated between 4-6 hours after the inset of an acute MI and remains elevated for 8-12 days.
Myoglobin-level increase within 1-4 hours after the onset of chest pain and highly sensitive but not very specific.
2. What is the most common precipitating event for MI?
In the most cases of MI plaque rupture followed by thrombus formation at the site is the precipitating event.
3. What is the rationale for using tissue plasminogen activator in the management of ACS?
Tissue plasminogen activator if fibrin specific. It binds to the fibrin of fresh clots and the resulting compound converts adjacent plasminogen into plasmin creating localized thrombolysis.
4. Why are morphine and nitroglycerin used to manage ischemic chest pain?
It’s a high priority to truce myocardial stimulation by the sympathetic nervous system. Morphine sulfate reduces anxiety and catecholamine secretion and it can reduces preload. And nitroglycerin decreases preload and reduces MVO2.
CS 3 15 points: C.J. is a 16-year-old high school student who is in the clinic for a
Discussion Questions
1. What changes in “cardiac enzymes” would be consistent with a diagnosis of MI?
Troponins(I and T specific to cardiac muscle cells), elevated between 4-6 hours after the inset of an acute MI and remains elevated for 8-12 days.
Myoglobin-level increase within 1-4 hours after the onset of chest pain and highly sensitive but not very specific.
2. What is the most common precipitating event for MI?
In the most cases of MI plaque rupture followed by thrombus formation at the site is the precipitating event.
3. What is the rationale for using tissue plasminogen activator in the management of ACS?
Tissue plasminogen activator if fibrin specific. It binds to the fibrin of fresh clots and the resulting compound converts adjacent plasminogen into plasmin creating localized thrombolysis.
4. Why are morphine and nitroglycerin used to manage ischemic chest pain?
It’s a high priority to truce myocardial stimulation by the sympathetic nervous system. Morphine sulfate reduces anxiety and catecholamine secretion and it can reduces preload. And nitroglycerin decreases preload and reduces MVO2.
CS 3 15 points: C.J. is a 16-year-old high school student who is in the clinic for a