Reference no: EM133364383
Assignment:
Case A
A 48-year-old patient woke up at night from pain in the epigastric region, accompanied by weakness, sweating, and nausea. Previously, the pain did not bother, he considered himself healthy. An attempt to stop the pain with a solution of soda did not bring relief. After taking Nitroglycerin under the tongue, the pain decreased, but did not completely disappear. Nausea, weakness, sweating persisted. In the morning, an ambulance was called. The ECG revealed a deep Q wave in III and aVF leads; the ST segment in the same leads is elevated above the isoline, arcuate, passes into a negative T wave; the ST segment in leads I, aVL, and V1 to V4 below the isoline.
Questions:
1. What is the most likely diagnosis for this patient?
2. Justify your diagnosis.
3. Make a plan for additional examination of the patient.
4. What is your further treatment tactics?
5. Specify contraindications to thrombolysis.
CASE B.
A 58-year-old patient was taken to the hospital from a dental clinic after tooth extraction with an attack of expiratory suffocation. History: bronchial asthma. Triple inhalation of Berotek was ineffective.
The patient's condition is severe, the patient is inhibited. Forced position (sitting, leaning on his hands). Diffuse warm cyanosis, swelling of the jugular veins, temperature 36.6°. Breathing is superficial, rapid (respiratory rate - 32 per minute), auxiliary muscles of the chest participate in breathing. Distant wheezing.
Auscultation of the "silent lung" zone on the left and right. Heart rate - 110 per minute, blood pressure - 110/70 mm. rt. Art.
1-Pathology of which system is most likely?
2-Name the emergency
3-List the main diagnostic criteria
4-Formulate a preliminary diagnosis
5-Name the main development mechanisms
6=Your tactics
7-Name urgent actions
8-Name the main groups of drugs used in emergency care
9-List the main complications
10-Name the possible outcomes
CASE C
A 59-year-old man was hospitalized at a cardiological dispensary from September 1 to September 14 due to anterior Q-forming myocardial infarction on September
1. He was admitted with complaints of intense pressing retrosternal pain radiating to the region of the left shoulder blade, shortness of breath that arose after a stressful situation.
From the anamnesis it is known that in the last 2 years, blood pressure has periodically increased to a maximum of 160/90 mm Hg. Art. He did not receive constant drug therapy, episodically took captopril 25 mg. During exercise, periodically there was discomfort in the region of the heart, shortness of breath.
He did not seek medical help. Smoked ½ pack of cigarettes a day for over 30 years. Family history: Father died of myocardial infarction at age 60. Works as a tower crane operator.
Upon admission, coronary angiography was performed, occlusion of the anterior interventricular artery was detected, PTCA and arthroplasty of the anterior interventricular artery were performed.
In the analyzes: total cholesterol - 6.36 mmol / l, LDL - 3.69 mmol / l, HDL - 1.25 mmol / l, TG - 2.26 mmol / l, fasting glucose - 4.5.
ECHO-KG: left ventricular hypertrophy, enlargement of the left atrial cavity. Local hypokinesia of the lateral wall of the left ventricle. Mitral regurgitation 2 tbsp., Tricuspid regurgitation 1 tbsp. Violation of the diastolic function of the left ventricle (VE / VA <1.0). PV - 48%.
The period of inpatient treatment was uneventful; after discharge, the patient was referred to a specialized cardiorehabilitation hospital, where he stayed until September 30.
The results of bicycle ergometry: submaximal heart rate - 137 beats per minute was achieved with a load of 100 watts.
6-minute walk test results: 412 meters walked in 6 minutes.
On September 30, he came to the clinic at the place of residence. Pain in the heart does not bother, shortness of breath appears when walking fast.
Constantly taking Aspirin 100 mg/day, Clopidogrel 75 mg/day, Atorvastatin 40 mg/day, Bisoprolol 2.5 mg/day, Lisinopril 5 mg 2 times a day.
On examination: the condition is satisfactory. BMI - 37 kg / m2. The skin is clean, normal color. Vesicular breathing in the lungs, no wheezing. NPV - 16 per minute.
Heart sounds are weakened, the rhythm is correct. Heart rate - 70 beats per minute, blood pressure - 150/100 mm Hg. Art. The abdomen is soft, painless on palpation in all departments. The liver and spleen are not enlarged. There are no edema. There are no dysuric disorders. The symptom of tapping in the lumbar region is negative on both sides.
Questions:
1. Suggest the most likely diagnosis.
2. Justify your diagnosis.
3. Develop a rehabilitation program at the outpatient stage.
4. Evaluate the data of laboratory tests and an objective examination of the patient, correct the drug therapy.
5. Specify the terms of temporary disability. Develop a follow-up plan.