Transcript Document

Clinical case no. 22
Presenter: Lin,Huei-Hsiu
(Caroline)
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A 50 y/o male came to the hospital accompanied by
relatives clutching of his chest complaining of sever
pain over substernal area radiating to the left jaw and
left arm. This was associated with cold clammy
perspiration and shortness of breath.
This accompanied with on and off chest pain
which was noted to have occurred by the time he was
diagnosed to be diabetic with FBS: 300mg/dl and
total cholesterol of 250mg 2 years ago.
Was given:
Nitroglycerin 5mg
Metoprolol 50 mg ½ tablet
Asprin 325mg 1 tab stat
Diagnosis:
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Angina Pectoris -> AMI
Heavy, squeezing pain of precordial or
substernal area
Radiates to back neck jaw groin
Occurs in Men 50-60 and in women 65-75
Angina pectoris
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3 types:
1. Classic Angina/Stable/angina of effort-imbalance
of oxygen caused by exertion and relieved by rest
2.Unstable angina/acute coronary syndromeepisodes of angina at rest caused by increased
epicardial tone, platelet clots, and thrmobi. Ass w
MI and death
3. variant/angiospastic angina/Prinzmetaltransient spasm of coronary artery, relieved by
nitrates and calcium channel blockers
Symptoms
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clutching chest
Severe substernal pain radiating to left jaw and
arm
Clammy cold
Shortness of breath
Signs:
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LVH
VS:
BP 160/100 CR 90/min
ECG findings: ST Elevation
Risk factors:
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LVH -> Heart Failure
Diabetic 300mg/dl -> Atherosclerosis -> MI
High cholesterol 250mg
BP: Moderately High 160/100
Dyspnea
Elder 50 year old patient
Treatment:
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Nitroglycerin 50mg
Nitrate and nitrite drugs:
Release NO -> relaxing the muscles, * vasodilation
Sublingual, oral, buccal, spray, IV, transderaml, ointment
Decrease ventricular vol and pressure
Decrease arterial pressure
Decrease ejection time
Vasodilation of epicardial coronary artery
Increased collateral flow
Result: Myocardial O2 requirement decreased and improved
perfusion
Treatment:
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Metoprolol 50 mg ½ tablet
Beta Blocker
Decrease HR and BP
Increase perfusion
Decrease rate of contraction
Recommended within 12 hours of MI
symptoms continued indefinitely. Admission
reducing mortality.
Treatment:
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Asprin 325mg 1 tab stat
Antiplatelet Agents:
Given immidiately on recognition of MI signs
and symptoms to be continued daily. It is a
*COX 2 inhibitor inhibiting the formation of
thromboxane 2
THE END