Question

Case study

Chief Complaint

“It feels like an elephant is sitting on my chest! I’m too young to die!”

HPI

Larry Stanton is a 46-year-old man transported by paramedics to the ED of a large community hospital. He presents with severe, substernal chest pain for the last 6 hours. He states he was fine until about an hour after he ate breakfast. The pain radiates to his jaw and neck and is accompanied by N/V and diaphoresis. In the ambulance, his chest pain is unrelieved by three SL NTG tablets.

PMH

No significant past medical history

FH

Father with heart failure and Type 2 DM and questionable history of “mild heart attack” at age 42; mother alive with HTN. He has one sister who is 48, alive and well, and one brother who died suddenly at age 46.

SH

(+) tobacco × 20 years; drinks beer usually on weekends; states he hasn’t been to a physician since his appendectomy 10 years ago

Meds

Acetaminophen PRN and Pepcid AC PRN

Therapeutic Alternatives

3.a. What nonpharmacologic therapeutic alternative can also achieve the immediate goal in this patient? The nonpharmacologic therapeutic alternative for Mr. Larry is to initiate reperfusion

3.b. What is the role of glycoprotein IIb/IIIa inhibitors (GPIs) in the setting of PCI with coronary artery stenting, and how should these agents be used?

3.c. How should therapy with GPIs be monitored?

Answer 1

3a) oxygen administration can help to relieve the chest pain. Oxygenation of the myocardial ischemic tissue will help to relieve the pain.

3b)The use of glycoprotein llb/lla inhibitors in the settings of percutaneous coronary intervention optimise outcomes and It reduces ischemic events in patients undergoing PCI.

Early administration of GPIs seemed more powerful because faster recanalization of the infarct related artery might attenuate the negative impact of any potential delay to PCI related to transfer and organizations logistics on clinical outcome.

These will prevent platelet aggregation and thrombas formation.They do so by inhibition of the Gpllb/ Gpll a receptor on the surface of the platelets.

Bolus if these agents frequently giving intracoronary.

3c)It have the risk for bleeding so the bleeding should monitor. It have the property for preventing clotting so during ang after the procedure there should be higher chance for bleeding,so bleeding shiuld be monitered.