Question

A 58 y/o female visits the Health center due to palpitations.

Medical background:

• H/O myocardial infarction in the past and with left ventricular failure, on the following medication:

o Valsartan 80 mg OD

o Furosemide 40 mg OD

o Spironolactone 25 mg OD

o Isosorbide dinitrate PRN

• History of Dyslipidemia since 10 yrs, on

o Atorvastatin 10 mg OD

• Non- Diabetic

History of present illness:

Present condition started few weeks now with palpitations associated with some giddiness, no associated chest pains, cold sweating nor malaise/fever.

Pertinent On Examination:

BP 105/70mmhg​PR 96/min​RR 21/min​Temp: 36.7 C

No anemia

Cardiac: mild tachycardia, irregular rhythm, no murmur

Lungs: Bibasilar crepitation

No edema

ECHO done Ejection fraction 45% with LA and LV, no clots seen

ECG: atrial fibrillation

IMPRESSION:

IHD (ischemic heart disease), CHF(congestive heart failure) , atrial fibrillation w/ normal ventricular respond

INVESTIGATIONS:

a. CBC/LFT/RFT/TFT/CRP/Lipids/Trop I/CKMB if needed

b. Chest XRAY

c. Echo after 6 months to 1 year

Discharge with additional meds:

1. Digoxin 0.25 mg,1 tab OD

2. Aspirin 81 OD

QUESTIONS

1. Explain the pathophysiology process of Myocardial Infraction?

2. Explain how the signs and symptoms of Myocardial Infraction develops.

3. What is the clinical significance of doing cardiac enzymes for the patient with MI?

4. List at least two complications of MI and explain how they develop?

1- write articles for this case.

Answer 1

Ans) 1) Myocardial infarction ("heart attack") is the irreversible damage of myocardial tissue caused by prolonged ischemia and hypoxia.

- Pathophysiology of Myocardial infarction:

• Artherosclerosis, arterial spasm, plaque, thrombus are cause of obstruction--> ischemia --> hypoxia.

• Reduced oxygen supply causes angina & thrombolysis causes unstable angina.

• Permanant thrombus causes tissue necrosis leads to Myocardial infarction.

2) Signs & Symptoms of Myocardial infaction:

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back

• Nausea, indigestion, heartburn or abdominal pain

• Shortness of breath

• Cold sweat

• Fatigue

• Lightheadedness or sudden dizziness.

3) Cardiac enzyme studies measure the levels of enzymes and proteins that are linked with injury of the heart muscle. The test checks for the proteins troponin I (TnI), troponin T (TnT) & creatine kinase (CK).

- Severe stress on the heart can damage its muscle. When that happens, heart releases certain enzymes -- a kind of protein -- into your blood. After a heart attack, the level of these enzymes can get very high.

4) Complications of Myocardial Infarction:

- Cardiogenic shock: Cardiogenic shock is defined as a hemodynamic state in which the heart cannot produce enough of a cardiac output to supply an adequate amount of oxygenated blood to the tissues of the body. This occurs after a Myocardial infarction.

- LV Dysfunction:
Depends on size, location of infarct, prior MI,
Preinfarct LV Function.