Presentation/History
A 52-year-old insuranceadjuster is brought to the hospital in an ambulance. His wife, whoaccompanied him, stated that during dinner he started to complainof excruciating chest pain in the region of the sternum. Thesesymptoms were accompanied by nausea, vomiting, and severe shortnessof breath. She also pointed out that for several years the patienthad been suffering from chest pain that radiated into the left arm,particularly after physical effort or emotional upsets.
Examination
On admission the patientappears in shock. His skin is ashen gray with some cyanosis (bluishtinge), and is cold and clammy. His blood pressure is low, hispulse is quite weak, and his pulse rate is 110 per minute. Hisrespirations are noisy and gasping. On auscultation of the lungs,abnormal breaths sounds are heard. His heart sounds are feebly andarrhythmic. In spite of oxygen application, intravenous injectionof circulatory stimulants, electric defibrillation and terminalcardiac massage, the patient expires within two hours of admission.At autopsy there is found marked narrowing of both coronaryarteries and many of their branches, due to atherosclerosis of thevessel wall. There is an old occlusion in the first portion of theright coronary artery and a fresh intimal hemorrhage in theanterior interventricular branch near its origin from the leftcoronary artery. This, in combination with a fresh blood clot, hascompletely occluded the anterior interventricularbranch.
Please give a diagnosis and treatmentplan for this patient
Presentation/History
A 52-year-old insuranceadjuster is brought to the hospital in an ambulance. His wife, whoaccompanied him, stated that during dinner he started to complainof excruciating chest pain in the region of the sternum. Thesesymptoms were accompanied by nausea, vomiting, and severe shortnessof breath. She also pointed out that for several years the patienthad been suffering from chest pain that radiated into the left arm,particularly after physical effort or emotional upsets.
Examination
On admission the patientappears in shock. His skin is ashen gray with some cyanosis (bluishtinge), and is cold and clammy. His blood pressure is low, hispulse is quite weak, and his pulse rate is 110 per minute. Hisrespirations are noisy and gasping. On auscultation of the lungs,abnormal breaths sounds are heard. His heart sounds are feebly andarrhythmic. In spite of oxygen application, intravenous injectionof circulatory stimulants, electric defibrillation and terminalcardiac massage, the patient expires within two hours of admission.At autopsy there is found marked narrowing of both coronaryarteries and many of their branches, due to atherosclerosis of thevessel wall. There is an old occlusion in the first portion of theright coronary artery and a fresh intimal hemorrhage in theanterior interventricular branch near its origin from the leftcoronary artery. This, in combination with a fresh blood clot, hascompletely occluded the anterior interventricularbranch.
Please give a diagnosis and treatmentplan for this patient
