Reference no: EM132644318
Mr. H.A. is a 58- year old white man who began to experience chest discomfort while playing tennis with friend. His friend brought him to the Emergency Room. Mr H.A. reported "I'm having pain in my chest and it goes up into my left shoulder, neck and jaw and down the inside of my left arm. I'm also having a hard time catching my breath and I feel sick to my stomach."
Mr. H.A.'s medical history includes hypertension for the last 12 years; Type II Diabetes mellitus last 5 years; Myocardial infarction (MI) 5 years ago treated with cardiac catheterization and angioplasty; chronic stable angina for the last 4 years; hypertriglyceridemia; colon polyps and BPH. Mr. H.A. is a smoker with an intake of 2 beers/week. Mr. H.A.'s family history includes father who died from an MI at age 55 (also had DM), mother died at 70 from breast cancer.
The attending ER nurse evaluates Mr. H.A. Some of the information gathered during the assessment is below:
Mr. H.A. is alert and oriented. He is anxious and appears to be in acute distress.
BP 160/98
Pulse (P): 105 with occasional premature beat
Respiration Rate (RR): 18 breaths per minute
Skin appears diaphoretic, pale and cool to the touch.
Slight bibasilar inspiratory crackles with auscultation, no wheezing or friction rubs, no dullness with percussion.
Normal S1 and S2, no S3 with slight S4. No murmurs or rubs. Tachycardia is noted. No pedal edema. Distinct bruit over the left femoral artery.
Blood test results: CK-MB= 6.3 IU/L, Troponin I 0.3ng/mL, Cholesterol=213 mg/dL, Triglycerides= 174 mg/dL, Glucose fasting= 264 mg/dL.
ECG: 4 mm ST segment elevation
Chest xray: bilateral mild pulmonary edema.
Given the above results, an emergency angiogram was performed which revealed 90% blockage in left anterior descending (LAD) artery.
1. Draw Mr. H.A.'s ECG tracing. What does an elevated S-T segment mean?
2. Which signs indicate that the left side of the heart is not working properly?
3. Explain why MI patients often present with the following signs and symptoms? What causes each to occur?
a. tachycardia.
b. mild pulmonary edema
c. skin diaphoretic