The And Pathogenesis Of Coronary Atherosclerosis And Myocardial Ischaemia

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

12 Lead Electrocardiogram (ECG) - There are typical changes to the normal pattern of the ECG in a heart attack. Patterns that occur include pathological Q waves and ST elevation (Koutoukidis, Stainton & Hughson 2013, p. 505). However, it is possible to have a normal ECG even if a patient has had a heart attack. The indicators for this test include: suspected myocardial infarction, suspected pulmonary embolism, perceived cardiac dysrhythmias, fainting or collapse, a third heart sound, fourth heart sound, a cardiac murmur or other findings to indicate structural heart disease. The

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

12 lead EKG: It is one of the tools for initial evaluation of patients suspected of coronary syndromes such as MI. It as a sensitivity of 80% (Kreatsoulas et al., 2016). ST segment changes of elevation or depression, left bundle branch block, presence of Q waves, new onset of T wave inversion are suggestive of ischemic changes of heart. In this case, then Intervention for cardiac catheterization with stent placement may be required (McConaghy & Oza, 2013).

Cardiovascular. Client denies chest pain, palpitations, murmurs, any arrhythmias, hypertension, awakening at night with shortness of breath, or dizzy spells. Client has not had an electrocardiogram.

A non-ST-elevation myocardial infarction (NSTEMI) is a type of heart attack; its counterpart, STEMI or ST-elevation myocardial infarction, is differentiated based on an EKG (electrocardiogram) test. Four processes are involved in the making of an NSTEMI: unstable plaque in arteries, the constriction of the coronary arteries, insufficient oxygen supply to the heart muscle, and narrowing of the coronary arteries from plaque development.2 It is differentiated from unstable angina, or chest pain, by the rise and fall of troponin levels

Using a criteria of a resting heart rate >100 bpm and an average heart rate of >90 bpm on 24-hour Holter monitoring, Still et al., estimated the prevalence of IST in a middle-aged population of men and women. The IST prevalence was 1.2% (7 of 604 patients) [2], including both symptomatic and asymptomatic patients. IST has also been reported in older population. [5] Although, IST is believed to be a chronic condition, long-term complications are few. IST has been associated with tachycardia-induced cardiomyopathy in isolated cases [6][7] and no mortality has been yet reported.

Electrocardiographic (ECG) is valuable, cheap, and noninvasive method used in diagnosis and risk stratification of ACS; accordingly it provides useful information regarding culprit artery by evaluation these ECG changes in regarding diagnostic angiography.

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.

This feature mainly performed in approximately one/ fourth (a quarter) of all patients; ensuring that the diagnosis of TTS syndrome is almost certain. In other words, it greatly reduces the chances of misdiagnosis. In inverted or reverse cases, this echocardiography is extremely important because it assists in detecting the disease early enough through clearly presenting the abnormalities of the wall motion. Furthermore, the fact that akinesia of all basal segments of left ventricle walls which have hyperdynamic apical walls are not limited to a single coronary territory, enables the syndrome to be recognized easily during echocardiography examination. Additionally, it is believed that ECHO is a tool that is indispensable especially during early diagnosis of Takotsubo syndrome and it can assist greatly in preventing unnecessary coronary

Myocardial infarction is known as a heart attack which is referring to the chronic coronary syndrome disease. According to the book of “Cardiopulmonary system, vital sign, electrocardiography, and CPR-Module D, the author Saunders define myocardial infarction as “ Cardiac tissue death that occurs when the coronary arteries are occluded (blocked) by an atheroma, a mass of fat or lipid on the wall of an artery, or a blood clot caused by an atheroma, and the heart muscle”. (Elsevier, 2010) My definition of myocardial infarction is myocardial means muscle of the heart and infarction means lack of oxygen. Therefore, this essay will discussed and elaborate on what is happening to the body when having heart attack, cause, effect, treatment and

Chest pain is a frequent complaint in the emergency department (ED). Patients who are symptomatic with ST-elevations on ECG are at high risk for ST-elevation MI (STEMI). While this classic ECG pattern has been identified as high risk for myocardial ischemia, recent literature has reported various STEMI-equivalents which may be equally threatening.8 One STEMI-equivalent previously named the de Winter pattern describes ECG changes where there are ST-segment depression in the precordial leads in association with tall, symmetrical, hyperacute T-waves.3 These changes have been associated with proximal left anterior descending (LAD) coronary artery occlusion.9 We have identified and report a case of de Winter ECG pattern immediately following

In 2014, myocardial infarctions were the second lead cause of death in Northern Ireland, proceeded only by malignant neoplasms. (Department of Finance and Personnel. (2015)

The first hour of the session I will give an introductory lecture about different approaches to ischemic heart disease. On the second hour, you will be presenting an articles “case report”. I have attached 3 articles to this email for you. You will work in pairs, each article will be presented by two of you.

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.