Answer the questions based on the following Medical Record:
History of present Illness: This 77 year old gentleman washospitalized with chest pain, and a diagnosis of myocardialinfarction was made. The patient had CPK elevation to 800 with 10%MB fraction. He subsequently developed heart failure and cardiacarrhythmia. He underwent cardiac catheterization and coronaryangiography. His ejection fraction was 30%. He has severe left maincoronary artery stenosis and right coronary artery occlusion. Thepatient has had carcinoid tumor of bowel resected 4-5 years ago andin a recent laparotomy he was found to have diffuse carcinoidinvolvement of the liver and mesentery. The patient did have smallbowel resection and currently has a colostomy. He is expected tolive 2-3 years.
Past Medical History: Long standing hypertension, colostomysecondary to bowel carcinoma, transurethral resection of theprostate, previous transient ischemic attacks, and bilateralcarotid disease with 60-70% stenosis.
Impression:
Severe coronary artery disease with recent with recent myocardialinfarction, high grade left main coronary artery stenosis andocclusion of right coronary artery, ischemic cardiomyopathy,ventricular and supraventricular arrhythmias
History of carcinomatosis, status post recent bowel obstruction,previous colostomy
Carotid occlusive disease with history of transient ischemicattacks.
Recommendation:
The patient and his family are fully aware of recent cardiaccatheterization findings. The patient is in agreement withproceeding with coronary artery bypass graft surgery, knowing thathe is expected to live 2-3 years. Informed consent has beenobtained.
1) What medical problems does the patient have? Explain these inlay terms, as if you were talking with the patient and hisfamily.
2) What does it mean to have a "30% ejection fraction?" Is thisgood or bad?
3) Describe the coronary artery bypass graft surgical procedure inlay terms.
4) What is carotid endartarectomy, and is this patient a good riskfor it? Why or why not?
Answer the questions based on the following Medical Record:
History of present Illness: This 77 year old gentleman washospitalized with chest pain, and a diagnosis of myocardialinfarction was made. The patient had CPK elevation to 800 with 10%MB fraction. He subsequently developed heart failure and cardiacarrhythmia. He underwent cardiac catheterization and coronaryangiography. His ejection fraction was 30%. He has severe left maincoronary artery stenosis and right coronary artery occlusion. Thepatient has had carcinoid tumor of bowel resected 4-5 years ago andin a recent laparotomy he was found to have diffuse carcinoidinvolvement of the liver and mesentery. The patient did have smallbowel resection and currently has a colostomy. He is expected tolive 2-3 years.
Past Medical History: Long standing hypertension, colostomysecondary to bowel carcinoma, transurethral resection of theprostate, previous transient ischemic attacks, and bilateralcarotid disease with 60-70% stenosis.
Impression:
Severe coronary artery disease with recent with recent myocardialinfarction, high grade left main coronary artery stenosis andocclusion of right coronary artery, ischemic cardiomyopathy,ventricular and supraventricular arrhythmias
History of carcinomatosis, status post recent bowel obstruction,previous colostomy
Carotid occlusive disease with history of transient ischemicattacks.
Recommendation:
The patient and his family are fully aware of recent cardiaccatheterization findings. The patient is in agreement withproceeding with coronary artery bypass graft surgery, knowing thathe is expected to live 2-3 years. Informed consent has beenobtained.
1) What medical problems does the patient have? Explain these inlay terms, as if you were talking with the patient and hisfamily.
2) What does it mean to have a "30% ejection fraction?" Is thisgood or bad?
3) Describe the coronary artery bypass graft surgical procedure inlay terms.
4) What is carotid endartarectomy, and is this patient a good riskfor it? Why or why not?
