Uploaded byIrene Soriano
MYOCARDIAL INFARCTION
A 48-year-old male patient arrived at the emergency room accompanied by friends with chest pain. He had been playing soccer and experienced pain in his chest on three occasions. The patient smokes 5 cigars per day and does not engage in regular physical activity. His father had died of a heart attack at age 55. The patient's chest pain was described as oppressive and radiating to his left arm. His medical evaluation found elevated blood pressure, obesity, and an unhealthy lifestyle. The case analysis indicates the patient likely suffered a myocardial infarction due to risk factors including age, family history of heart disease, smoking, obesity, hypertension, and sedentary lifestyle.
More Related Content
](https://cdn.slidesharecdn.com/ss_thumbnails/acutemyocardialinfarctionfinal2-13071089996043-phpapp02-110603085323-phpapp02-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to MYOCARDIAL INFARCTION
More from Irene Soriano
MYOCARDIAL INFARCTION
- 1. ENGLISH Clinic case ENGLISH Clinic case Saturday28th 2015Saturday 28th 2015 Irene Marleny Soriano Villalobos Jerson André Vigo Rabanal Carlos Felipe Chero Gallardo Irene Marleny Soriano Villalobos Jerson André Vigo Rabanal Carlos Felipe Chero Gallardo
- 2. A male patientof 48 years old arrive to the emergency service to the Regional Hospital; he comes with his friends; the patient refere that they was playing soccer and he felt a pain in the chest for three opportunities; the first two times the pain was calmed when he stopped to play but in the three time do not calm for this motive he comes to the hospital.
- 3. LIFE STILE The patientsmoke 5 cigars for day and dont have much fisic activity; he only plays soccer one time at the month. FAMILIARY ANTECEDENTS His father died at 55 years caused for a hearth attack The patient indicate that the pain is behind the sternum and the kind of the pain is oppressive; and the pain is reflected in the left arm too; this symptom start one hour ago.
- 4. Fisic Exam Arterial Pressure:130/89 mmHg Heartbeat: 80 lpm Respiratory Frecuency: 22 rfm Temperature: 36,5 ºC Stature: 1,60 mt. Weight: 85 kg Abdominal Circunferency: 110cm Body mass index: 32,2
- 5. Acts: • Patient male •Arrive to Emergency service of the Regional Hospital. • Comes accompanied with his friends • He was playing soccer • Smoker and sedentary life. • His father died for a head attack. Health Problems: 1.- pain in the chest of kind oppresive 2.- the pain is reflected in the left arm 3.- Obesity 4.- Arterial Hypertension 5.- Style of life unhealthy Case AnalysisCase Analysis
- 6. Associated factorsAssociated factors Age Sex Family history Age Sex Family history Tobacco Hypercholesterolemia Hypertension Diabetes Obesity Alcohol Emotional distress Tobacco Hypercholesterolemia Hypertension Diabetes Obesity Alcohol Emotional distress Unchangeable Modifiable
- 7. AFFECTED STRUCTURE THE HEART •Is a muscular organ that is the main part of the circulatory system, It is the responsible for pumping blood to all the parts of the body • Is divided in 4 cavities; this cavities are left and right atrium, left and right ventricles ; the part of the right heart have blood with few oxygen and the part of the left heart have blood with so much oxygen. • Is an self controlled organ because it have some muscular fibres that have modification and generate electric pulses. the heart have two fases; the first one called sistole (contraction) and the other called diastole (chamber filling)
- 8. The irrigation ofthe heart is by the coronary arteries; this arteries are originated in the ascendant part of the aorta artery; specifically in the aortic sinuses or sinuses of Valsalva both the right and left side. The coronary arteries are two : the right coronary and the left coronary The left coronary is divided in descending anterior artery and the circunfleja artery. This arteries are responsible of the irrigation to the anterior and lateral part of the left ventricle. The right coronary is divided in descending posterior artery that is the responsible of the irrigation of the lower wall of the heart There are different types of coronary diseases but the most frequent and most clinically relevant is coronary atherosclerosis and it can be produce to ischemic heart disease.
- 10. Male patient 48 years Myocardial infarction Bloodflow Poor blood supply Tissue damage Obstruction Atheroma Personal record Obesity Excessive fat intake LDL HDL Chest pain Oppressive Retroesternal Referred to left arm Emergency Sick time: 1 hour Endothelium of arteries
- 11.
- 12. Acute ManagementAcute Management Oxygen therapy GTN (½ sublingual tab) Aspirin 300mg IV morphine 2.5~5mg + IV metoclopramide 10mg Oxygen therapy GTN (½ sublingual tab) Aspirin 300mg IV morphine 2.5~5mg + IV metoclopramide 10mg
- 13. Hospital ManagementHospital Management Aspirin,GTN, morphine, oxygen if not already given Monitor oximetry, BP, continuous ECG 12 lead ECG, IV access, cardiac enzyme Aspirin, GTN, morphine, oxygen if not already given Monitor oximetry, BP, continuous ECG 12 lead ECG, IV access, cardiac enzyme
- 14. STEMISTEMI Reperfuse ASAP(within 12hrs of onset of sx – i.e. before MI is complete): Antiplatelet therapy (aspirin and clopidogrel ± GPIIb/IIIa inhibitor) Anticoagulation agent (unfractionated heparin or LMWH) Immediate PCI or fibrinolytic therapy – PCI has higher reperfusion rate and is better if pt present > 1hr but thrombolysis is gold standard if pt arrive within an hour Reperfuse ASAP (within 12hrs of onset of sx – i.e. before MI is complete): Antiplatelet therapy (aspirin and clopidogrel ± GPIIb/IIIa inhibitor) Anticoagulation agent (unfractionated heparin or LMWH) Immediate PCI or fibrinolytic therapy – PCI has higher reperfusion rate and is better if pt present > 1hr but thrombolysis is gold standard if pt arrive within an hour
- 15. STEMISTEMI Subsequent management(start during this hospital admission) Statins, aspirin and clopidogrel, ACEI (or ARB), β-blocker (if CI then CCB) Nitrates PRN Cardiac rehabilitation Antiplatelet post stent Aspirin for life Clopidogrel for at least 6wks for metal stent Subsequent management (start during this hospital admission) Statins, aspirin and clopidogrel, ACEI (or ARB), β-blocker (if CI then CCB) Nitrates PRN Cardiac rehabilitation Antiplatelet post stent Aspirin for life Clopidogrel for at least 6wks for metal stent
- 16. UA and NSTEMIUAand NSTEMI Stabilize acute coronary lesion Anti-platelet (aspirin and clopidogrel ± GPIIb/IIIa inhibitor) Anti-thrombin (UFH or LMWH) Anti-ischaemia (β-blocker if CI then CCB, consider nitrates, morphine) High risk – urgent angiography ± PCI Low risk – arrange stress tests Subsequent management (start during this hospital admission) Statins, aspirin and clopidogrel, ACEI (or ARB), β- blocker (if CI then CCB) Nitrates PRN Cardiac rehabilitation Stabilize acute coronary lesion Anti-platelet (aspirin and clopidogrel ± GPIIb/IIIa inhibitor) Anti-thrombin (UFH or LMWH) Anti-ischaemia (β-blocker if CI then CCB, consider nitrates, morphine) High risk – urgent angiography ± PCI Low risk – arrange stress tests Subsequent management (start during this hospital admission) Statins, aspirin and clopidogrel, ACEI (or ARB), β- blocker (if CI then CCB) Nitrates PRN Cardiac rehabilitation
- 17. Diet Physical activityTabacco Control cardiovascular risk What can I do to avoid a myocardial infarction?