Case Study:
Initial history
40-year-old male complaining of substernal chest pain that began approximately 30 minutes
Before he came to the emergency department
Pain has eased slightly but is still present, was 8/10 in severity, now 5/10
Additional history
Also feels pain in his left shoulder
Feels short of breath and somewhat sick to his stomach, but has not vomited
Denies coughing, fever, or change in the nature of the pain with deep breathing
40pack/year history of smoking
Blood pressure has been a little elevated (148/92mmHg) on his last two vistis to his nurse practitioner
Eats a lot of fatty foods but says his total cholesterol doesnât change no matter what he eats; it was 242mg/dL last month
Father has angina that began at age 53
Denies diabetes
Exercises regularly and has not gained weight
Says he has had a couple of episodes of shortness of breath while jogging but attributed it to âgrowing oldâ
Has never been hospitalized except for one case of influenza complicated by pneumonia 3 years ago
Perceives himself as very healthy, is on no medications, and has no known allergies
Physical Examination
Alert, moderately anxious man in mild distress.
T=37 orally, P=100 with occasional premature beat, RR=24, BP=160/98 in both arms (sitting).
Skin warim and disphoretic without cyanosis
PERRLA, fundi benign, pharynx clear
Neck supple withour thyromegaly, adenopathy, or bruits
<2cm jugular venous distention
Tachypneic, mild use of accessory muscle of respoiration
No tenderness upon palpation of the chest wall
No dullness to precussion
Slight inspiratory crachles (rales) heard at both bases without egophony
No Rubs
Abdomen with bowel sounds heard throughout, no organomegaly or tenderness, no bruits, rectal guaiac negative
Extremities with full and symmetric pulses; slight bruit over left femoral artery, no pedal edema
Alter and oriented, neurologic examination intact to cognition, strength, sensation, gait, and deep tendon reflexes.
Diagnostic results
ECG shows 4mm ST elevation with T-wave inversion in the anterior precordial leads with occasional premature ventricular contraction
Oximetry shows oxygen saturation of 95%
Chest radiograph with borderline cardiomegaly and mild pulmonary congestion without acute infiltrates or pleural disease and no widening of the mediastinum.
Electrolytes and CBC normal
PT and PTT normal
CPK-MB normal
Troponin I normal
Please explain the pathophysiology and related treatment for this case study?
Case Study:
Initial history
40-year-old male complaining of substernal chest pain that began approximately 30 minutes
Before he came to the emergency department
Pain has eased slightly but is still present, was 8/10 in severity, now 5/10
Additional history
Also feels pain in his left shoulder
Feels short of breath and somewhat sick to his stomach, but has not vomited
Denies coughing, fever, or change in the nature of the pain with deep breathing
40pack/year history of smoking
Blood pressure has been a little elevated (148/92mmHg) on his last two vistis to his nurse practitioner
Eats a lot of fatty foods but says his total cholesterol doesnât change no matter what he eats; it was 242mg/dL last month
Father has angina that began at age 53
Denies diabetes
Exercises regularly and has not gained weight
Says he has had a couple of episodes of shortness of breath while jogging but attributed it to âgrowing oldâ
Has never been hospitalized except for one case of influenza complicated by pneumonia 3 years ago
Perceives himself as very healthy, is on no medications, and has no known allergies
Physical Examination
Alert, moderately anxious man in mild distress.
T=37 orally, P=100 with occasional premature beat, RR=24, BP=160/98 in both arms (sitting).
Skin warim and disphoretic without cyanosis
PERRLA, fundi benign, pharynx clear
Neck supple withour thyromegaly, adenopathy, or bruits
<2cm jugular venous distention
Tachypneic, mild use of accessory muscle of respoiration
No tenderness upon palpation of the chest wall
No dullness to precussion
Slight inspiratory crachles (rales) heard at both bases without egophony
No Rubs
Abdomen with bowel sounds heard throughout, no organomegaly or tenderness, no bruits, rectal guaiac negative
Extremities with full and symmetric pulses; slight bruit over left femoral artery, no pedal edema
Alter and oriented, neurologic examination intact to cognition, strength, sensation, gait, and deep tendon reflexes.
Diagnostic results
ECG shows 4mm ST elevation with T-wave inversion in the anterior precordial leads with occasional premature ventricular contraction
Oximetry shows oxygen saturation of 95%
Chest radiograph with borderline cardiomegaly and mild pulmonary congestion without acute infiltrates or pleural disease and no widening of the mediastinum.
Electrolytes and CBC normal
PT and PTT normal
CPK-MB normal
Troponin I normal
Please explain the pathophysiology and related treatment for this case study?
