Myocardial Infarction Redefined, Case Study Example

KK, a 62 year old female is seen in the Emergency Room following a morning of “feeling off.” She has never felt like this before. She reports that she has had no recent illnesses and has not traveled recently. KK is negative for: fever, chills, diarrhea, abdominal pain, nausea, vomiting, or headache.  She began feeling dizzy during mid-morning. She reports feeling like her heart was pounding at the same time. She was delivered to the hospital by noon where she was seen almost immediately. She has no chest pain but she feels “like a heavy weight is on top of her chest.”  There is no history of heart disease. Patient is alert and oriented.

Vital signs:

BP: 102/50

HR: 140

RR: 16

Temp: 37.2 degrees C

State the normal range of each vital sign and state whether this patient is low, normal, or high compared to normal values.

A normal systolic blood pressure is less than 120 and a normal diastolic blood pressure is lower than 80 (Vasan et al., 2012). Based on this reading, KK has a normal blood pressure. A normal heart rate is between 60 and 100 beats per minute, which means that 140 is a high heart rate. The normal respiratory rate is between 12 and 30 breaths per minute, so the reading of 16 indicates that this value is normal. Normal body temperature ranges between 36.5 and 37.2 degrees Celsius, so the body temperature reading is considered normal as well.

Identify the overall goal if you were in charge of taking care of this patient.

The overall goal if I were in charge of taking care of this patient would be to determine the cause of the heavy feeling on her chest. This is most likely a result of a heart problem, which is indicated by the abnormal heart rate and the sensation of pain in the chest. It would therefore be necessary to listen to the patient’s heart and ask her questions related to her level of activity and related health history. Furthermore, additional tests should be conducted to determine what type of disease is being experienced (Neumar et al., 2010).

What would be your overall plan?

• What tests would you run and how would the results of each test help you achieve your goal?

Electrocardiogram testing was done to determine heart irregularities, echocardiogram will be used to look at the heart’s structure and function, and a CT scan will be used to verify findings (Alpert et al., 2000).

• What things should be done first to treat this patient and why?

The heart should be listened to using a stethoscope to determine any potential irregularities.

• What are the three major groups of possible etiologies of the patient’s tachycardia?

The three major groups include rheumatic heart disease, hypertensive heart disease, and ischemic heart disease (Neumar et al., 2010).

Name the medications & manipulations that could help you diagnose this patient and how they are used.

ACE inhibitors can be used to determine if lowered blood pressure resolves the problem, beta blockers can be used to widen arteries and lessen the stress on the heart, aspirin can be used to decrease the tendency of the blot to clot, and statins can be used to lower blood cholesterol (Neumar et al., 2010).

Given the following results of an ECG (below), and the possible results of medications/manipulations in #4, what is your diagnosis of this patient?

Based on this evidence, it is likely that the patient has angina which is making it difficult for blood to enter her heart (Lewis et al., 1983).

What would be your follow up plan with this patient?

The patient will be placed on an aspirin regimen that will thin the blood and make it easier to flow through the heart (Lewis et al., 1983). The patient will be asked to come in again after two weeks to determine if additional medications should be added to the treatment process. Furthermore, the follow up will ensure that the patient is making healthy lifestyle choices that are indicated for individuals living with angina.

References

Alpert JS, Thygesen K, Antman E, Bassand JP (2000). Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol, 36 (3): 959–69

Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, Schnaper HW, LeWinter MM, Linares E, Pouget M, Sabharwal SC, Chesler E, DeMots H. (1983). Protective Effects of Aspirin against Acute Myocardial Infarction and Death in Men with Unstable Angina — Results of a Veterans Administration Cooperative Study. N Engl J Med, 309: 396-403.

Neumar RW, Otto CW, Link MS. (2010). Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(18 Suppl 3): S729–67.

Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D. (2001). Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease. N Engl J Med,    345:1291-1297.