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Acute Myocardial Infarction - Essay Example

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A 29-year-old female patient was admitted to the internal medicine department with epigastric pain, continuous colic, nausea, and vomiting. The ECG demonstrated an old anterior wall myocardial infarction…
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Acute Myocardial Infarction
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Acute Myocardial Infarction

Download file to see previous pages... Seven days later, the patient had sudden onset orthopnea, followed by respiratory and cardiac arrest. The patient was transferred to the ICU after cardiopulmonary resuscitation. The patient's BP was 80/40 mm Hg; the pulse was 130 bpm. The shock was corrected via the application of the presser and respirator supported ventilation. During the ICU monitoring, an ultrasound system was used on the patient for daily monitoring. Respiration enhanced pain, while leaning forward alleviated and she described left arm radiation. She also complained of nausea, vomiting and diarrhea for the past week. She had no past medical or surgical history (Ashikaga et al, 2007). Cardiac risk factors were active cigarette smoking (2 pack-years), obesity (BMI 33.3 kg/m2) and a sedentary life-style. Usual medication was oral estroprogestative contraception introduced 2 weeks prior to admission and paracetamol. History was inconsistent with past or present drug abuse. Physical examination revealed elevated blood pressure at 160/80 mm Hg and a regular tachycardia at 110 beats per minute. Respiratory frequency, temperature, and oxygen saturation, were however normal. Pulmonary and cardiac auscultation was normal, as well an abdominal examination. A chest X ray was unremarkable. Initial ECG showed sinus tachycardia with anterolateral ST elevation as well as inferior ST depression. Laboratory reports revealed an elevated troponin Ic at 0.69 ?g/l, CK was within normal limits and CRP was slightly elevated at 19 mg/l; the rest of the workup, including a complete toxicological-screen, was normal, and a pregnancy test was negative. Acute Myocardial Infarction Acute Myocardial Infarction (AMI) is considered to be irreparable myocardial cell death ensuing from ischemia. Various diagnostic features aid in determining AMI encompassing sustained regional ST rise through ECG, cardiac enzyme studies etc. The cardiac enzyme studies classifies AMI as Q-wave infarction (previously called transmural) and non Q-wave infarction (previously called subendocardial). Q- wave infarctions are related with atherosclerosis that comprise major coronary artery, it involves the entire width of the cardiac muscles thereby resulting in absolute occlusion blood supply in that region. On the other hand in case of non Q-wave infarctions, only a small area is affected as a result of diminished blood supply either due to obstruction by an atherosclerotic plaque, that may or may not be accompanied by superimposed thrombus. Two chief theories were proposed to understand the AMI (a) hemorrhage turning into a plaque, expansion of the plaque obstructs the lumen (b) removed or injured endothelium above the plaque, causing attachment of the platelet thrombus, resulting in more thrombus formation (Pain Ladder). Epidemiology Acute myocardial infarction is the most common presentation of ischemic heart disease. According to the WHO estimate (2002), 12.6 percent of deaths across the world were attributed to ischemic heart disease, in developed nations as well as it emerged as a third major cause of death in developing nations, after AIDS and lower respiratory infections. In developed nations like United States, deaths from heart disease are more abundant than the mortality from cancer. One in five deaths in the United States is due to coronary attacks. It is reported that >1 million people suffer a coronary attack per year, of these 40 percent die as a result of stroke. Thus, an American dies every minute from a coronary episode pathological state. It also suggests that the patient is not treated of gastritis for a certain time and the patient is subjected to constant stress. In India, cardiovascular disease has emerged as the leading cause of death. ...Download file to see next pagesRead More
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