Discussion with 2

Alexander is a 55-year-old carpenter who arrived at our clinic complaining of nausea, shortness of breath, chest and abdominal pain, and left neck pain. Supplemental oxygen was administered along with an electrocardiogram. EKG results displays an elevation on ST segment on leads V1-V6 that is interpreted as anterior wall myocardial infarction (STEMI) along with cardiac blood markers results that indicate increase in troponin 1, and creatine kinase (CK-MB).

Administration of nonenteric-coated chewable aspirin was given along with nitroglycerin, morphine for pain, lidocaine to prevent ventricular arrythmia, clopidogrel to break down clots (fibrinolytic) and heparin to prevent further clot formation.

Family history indicates hypercholesterolemia, diabetes, heart disease, hypertension, diabetes, and depression. Social history and lifestyle choices indicate recent divorce, new residence, full-time employment, drinking four cups of coffee daily, social drinking twice a week, and walking on weekends.

Vital signs:

BP: 180/98

T: 98.1 F

RR: 16 p/m

HR: 100 bpm

Pain: patient stated 9 in 1-10 pain scale

Comprehensive Metabolic Panel:

Glucose: 250 mg/dl

Calcium: 9mg/dl

Albumin: 4.4 g/dL

Total Protein: 7mg/dl

Sodium: 140 mEq/L

Potassium: 4.2 mEq/L

Bicarbonate (CO2): 23mEq/L

BUN: 7mg/dl

Creatinine: 1.2 mg/dl

Alanine amino transferase (ALT): 20 U/L

Aspartate Amino transferase (AST): 30 U/L

Bilirubin: 1mg/dl

Lipid Panel

Total cholesterol: 300 mg/dl

LDL:300 mg/dl

HDL:40 mg.dl

Triglycerides: 450 mg/dl

Patient was prepped and taken to CATH Lab. Catherization displayed 90 % occlusion of LAD coronary artery. PCTA was performed and bare-metal stent was placed. Revascularization was successful.  

Review the following case and answer the questions that follow. Collaborate with other classmates. Be sure to ask them questions that will help to keep the conversation going. You may need to do some outside research but put your answers in your own words. 

1. Do you see any risk factors that might have contribute to Alexander’s MI?

2. What is normal blood pressure, and heart rate?

3. Is there anything abnormal in the CMP? Could it contribute to heart disease?