Question

Mr. Hunt presents to the emergency department reporting excruciating chest pain. He is a 76-year-old white male who has been working in his yard for the past several days. He reports that the pain has gotten increasingly worse, and he just knows he is going to have a heart attack and die. He is immediately placed on a cardiac monitor and given nasal O2at 2 L/min. (Learning Objectives: 12, 15, 16, and 17)

1. What questions would be helpful at this point?

Mr. Hunt reports that the sharp pain started about 2 days ago and it has gotten so bad that he cannot lie down. He rates the pain as an 8 on a scale of 1 to 10, and it radiates to his neck and back. It is much worse when he takes a deep breath, but leaning forward seems to help him. He is on lisinopril for his high blood pressure and denies any other health problems. Family history is significant for heart disease and hypertension.

2. What labs would be helpful in confirming or ruling out a myocardial infarction, and what are the advantages of each?

3. If Mr. Hunt has acute coronary syndrome, what ECG changes are expected?

4. What interventions may be instituted if Mr. Hunt has acute coronary syndrome?

When the nurse auscultates his heart, she hears a pericardial friction rub. His ECG shows normal sinus rhythm, and all labs are within normal limits except for an elevated white blood cell (WBC) count. His vital signs are BP, 128/78; HR, 76; RR, 14; and T, 99. Based on these findings, the health care provider makes a diagnosis of pericarditis.

4. What is pericarditis and how is it diagnosed?

5. How is pericarditis treated?

Answer 1

Myocardial infraction is known as a heart attack, occurs when blood flow decreases or stops to a part of the heart causing damage to the heart muscles.The most common symtom is chest pain

Lab test to confirm Mi:

• TROPONIN: is a contractile protein that is not normally found in serum. it is released only when myocardial necrosis occurs.
• Complete blood cell count
• Comprehensive metabolic panel

Acute coronary syndrome: is a condition brought on by a sudden reduction or blockage of blood flow to the heart.

ECG changes in ACS: Inferior and lateral STE-ACS. There is ST elevation in the leads II,III, aVF, and V4-V6. Leads I and aVL show reciprocal ST depression. ST elevation in leads V1-V2 represents lateral "mirror image" ST deviation. There is sciarovsky- Birnbaum grade III of ischemia in leads III, aVF and V6.

PERICARDITIS: is an inflammation of the pericardium, the fibrous sac surrounding the heart.

DIAGNOSIS of pericardits: Blood test= increased urea, increased blood creatinine. ECG may demonstrate a 12 lead electrocardiogram with diffuse, non specific concave, ST segment elevation in all leads except aVR and V1 and PR segment depression possible in any lead except aVR, Sinus tachycardia and low voltage qrs complex.

Treatment of pericarditis: Treatment in viral or idiopathic pericarditis is with Asprin, non steroidal anti inflammatory drugs, colchicine decreases the risk of further episodes of pericarditis.