Cardiovascular Case Study #2

clinical history A 55-year-old man was brought to the emergency department by ambulance. He woke up at 6 AM feeling a crushing pain over his chest. He has had previous attacks of precordial pain, mostly while walking outside in cold weather or when running with his dog. As of late the pain would appear while he was at rest as well, but it was never as severe as now. He has diabetes and arterial hypertension for which he takes medication.

He was given an aspirin and transferred to the coronary intensive care unit by 8AM.

Physical findings He is obese, short of breath, sweating, and obviously in acute distress. His pulse rate is 90 and the blood pressure is 100/60 mm Hg.

Laboratory and clinical findings At the time of admission the serum levels of myoglobin, troponin I and T, and creatine kinase MB were within normal limits. The ECG showed sinus tachycardia, but no other abnormalities.

Outcome He had a coronary angiography and a stent was inserted. He was treated for a few days in the coronary care unit and recovered completely.

Questions for you to answer:

1. What is the pathogenesis and what are the possible causes of chest pain of sudden onset?

2. What is the significance of precordial pain that occurs during effort in contrast to precordial pain that occurs at rest?

3. Is the history of diabetes and hypertension important for the understanding of the present illness of this patient?

4. Why was he given aspirin?

5. Is it possible that this patient has an MI even though the laboratory findings do not support that diagnosis? When could one expect a rise of serum levels of myoglobin, troponin, and CK-MB?

6. Is the ECG always abnormal in patients with acute MI?