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Clinical case no. 22

Clinical case no. 22. Presenter: Lin,Huei-Hsiu (Caroline).

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Clinical case no. 22

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  1. Clinical case no. 22 Presenter: Lin,Huei-Hsiu (Caroline)

  2. 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

  3. Diagnosis: • 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

  4. Angina pectoris • 3 types: • 1. Classic Angina/Stable/angina of effort-imbalance of oxygen caused by exertion and relieved by rest • 2.Unstable angina/acute coronary syndrome-episodes of angina at rest caused by increased epicardial tone, platelet clots, and thrmobi. Ass w MI and death • 3. variant/angiospastic angina/Prinzmetal- transient spasm of coronary artery, relieved by nitrates and calcium channel blockers

  5. Symptoms • clutching chest • Severe substernal pain radiating to left jaw and arm • Clammy cold • Shortness of breath

  6. Signs: • LVH • VS: • BP 160/100 CR 90/min • ECG findings: ST Elevation

  7. Risk factors: • LVH -> Heart Failure • Diabetic 300mg/dl -> Atherosclerosis -> MI • High cholesterol 250mg • BP: Moderately High 160/100 • Dyspnea • Elder 50 year old patient

  8. Treatment: • 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

  9. Treatment: • 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.

  10. Treatment: • 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

  11. THE END

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