Myocardial Infarction
• Discuss a brief HPI, Pertinent subjective and objective complaint data.
69 y/o male with known history of MI, CAD, HTN, Hyperlipidemia, Stent x2, obese. Presented to the ER via EMS from the local courthouse after feeling faint, weak, pale appearing, sob. On arrival patient saturation low 90s, tachycardic, SBP >160. Patient states “I feel some chest pressure, feels like the last heart attack started.” Denies chest pain radiates. Denies any headache, light- headed, dizziness, n/v/d.
HC: Troponin x2 elevated 0.9-1.0. EKG appears ST elevation leads V1-V2. Heparin drip started. Nitro x2 is given with chest pain relief. SBP 150-160. Sat 95% on 2L. Patient being transferred to the city for possible cardiac catheter/cardiology specialty services.
• Pick one disorder to explore related to the case and summarize the pathophysiology behind the disorder.
Myocardial Infarction
• Present the current management recommendations for the disorder. This must be based on current evidence or guidelines.
• Discuss the actual plan that was implemented in the clinical setting for this patient.
o Were guidelines followed? If not please explain further.
o When discussing the plan, address labs that were ordered, medications prescribed/ordered, referrals or consultations.
o Discuss WHY each of the components of the plan were implemented.
Sample Solution
Myocardial infarction (MI), colloquially known as “heart attack,” is caused by decreased or complete cessation of blood flow to a portion of the myocardium. MI may be “silent,” and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death. When a patient with suspected acute MI reaches the emergency department, evaluation and initial management should take place promptly, because the benefit of reperfusion therapy is greater if therapy is initiated earlier. Although the immediate priority in managing acute myocardial infarction is thrombolysis and reperfusion of the myocardium, a variety of other drug therapies such as heparin, magnesium and insulin might also be considered in the early hours.
