CASE DISCUSSION ON ACUTE MYOCARDIAL INFARCTION
Bhavani Vegesena
roll no:141
He is well oriented to time , place and person.
He is thinly built and moderately nourished.
VITALS:
TEMPERATURE: afebrile
PULSE RATE: 48bpm
BLOOD PRESSURE: 110/80 mm hg
RESPIRATORY RATE: 14 cycles/min
SPO2: 96%
GRBS: 626mg/dl
On evaluation his GRBS was very high. He was immediately given 6U oh HAI iv and then his GRBS was checked which showed 506mg/dl so he was administered 16U of Actrapid.
JVP: normal
No icterus, lymphadenopathy, edema.
SYSTEMIC EXAMINATION:
CVS: SI, S2 heard. No murmurs
RS: BAE + , NVBS
ABDOMEN: Soft and non tender
CNS: NAFD
INVESTIGATIONS:
COMPLETE URINE EXAMINATION:
BLOOD SUGAR- FASTING:
The patient was immediately treated for high blood sugar by giving 20U of actrapid.
LIVER FUNCTION TESTS:
INTERPRETATION: high total bilirubin, hypoalbuminemia.
RENAL FUNCTION TESTS:
INTERPRETATION: increased urea, creatinine, uric acid and hyponatremia.
ELECTROCARDIOGRAM:
INTERPRETATION: elevations in lead 2 and lead 3 and AVF.
PROVISIONAL DIAGNOSIS:
Information based on the above investigations is suggestive of inferior wall MI with uncontrolled sugars with k/c/o DM since 8yrs.
TREATMENT:
On evaluation of the investigations, the patient was immediately administered with antiplatelets and anticoagulants STAT dose prophylactically and was advised for thrombolysis. The patients attenders wanted a cardiologist opinion ,so the patient has been referred to a higher center in view of PTCA.
DRUGS GIVEN:
TAB. ASPIRIN 325 mg PO/STAT
TAB ATORVAS 80mg PO/STAT
TAB CLOPIBB 300mg PO/STAT
INJ HAI 6U/IV STAT
VITAL MONITORING.
The patient was shifted to a higher center where he underwent angioplasty and a stent was placed. He was later discharged.
The patient is currently doing fine.
Clinical indications for PCI include the following:
- Acute ST-elevation myocardial infarction (STEMI)
- Non–ST-elevation acute coronary syndrome (NSTE-ACS)
- Unstable angina.
- Stable angina.
- Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope)
- High risk stress test findings.
Reference: https://emedicine.medscape.com/article/161446-overview
MYOCARDIAL INFARCTION:
Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia).
Reference: https://emedicine.medscape.com/article/155919-overview
ETIOLOGY:
Causes:
- Atherosclerosis – Also known as coronary artery disease, this condition is the most common cause of heart attacks and occurs when the buildup of fat, cholesterol, and other substances forms plaque on the walls of the coronary arteries
- Coronary artery spasm – A rare cause of blockage, spasms of the coronary arteries can cause them to become temporarily constricted.
- Coronary artery tear – Also known as a spontaneous coronary artery dissection, a tear in a coronary artery can prevent blood from reaching the heart and cause a heart attack.
- High cholesterol
- Hypertension
- Smoking
- Illicit drug abuse
- Obesity
- Stress
- Type 1 DM
- Family history
Pain or discomfort that spreads to the shoulders, neck, arms, or jaw
Chest pain that gets worse
Chest pain that doesn't get better with rest or by taking nitroglycerin
- Sweating, cool, clammy skin, or paleness
- Shortness of breath
- Nausea or vomiting
- Dizziness or fainting
- Unexplained weakness or fatigue
- Rapid or irregular pulse
- Intravenous therapy, such as nitroglycerin and morphine
- Continuous monitoring of the heart and vital signs
- Oxygen therapy to improve oxygenation to the damaged heart muscle
- Pain medicine to decrease pain. This, in turn, decreases the workload of the heart. The oxygen demand of the heart decreases.
- Cardiac medicine such as beta-blockers to promote blood flow to the heart, improve the blood supply.
- Fibrinolytic therapy. This is the intravenous infusion of a medicine that dissolves the blood clot, restoring blood flow.
- Antithrombin or antiplatelet therapy with aspirin or clopidogrel.
- Antihyperlipidemics. These medicines lower lipids (fats) in the blood, particularly low density lipid (LDL) cholesterol.
- Balloon angioplasty
- Coronary stent
- Atherectomy
- Laser angioplasty
Coronary stenting in patients undergoing PTCA during acute MI. https://pubmed.ncbi.nlm.nih.gov/8651117/
Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes.https://pubmed.ncbi.nlm.nih.gov/15674954/
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